Provider Demographics
NPI:1497728380
Name:COHEN, BRIAN H (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:H
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2943
Mailing Address - Country:US
Mailing Address - Phone:313-562-5800
Mailing Address - Fax:313-562-6418
Practice Address - Street 1:2120 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2943
Practice Address - Country:US
Practice Address - Phone:313-562-5800
Practice Address - Fax:313-562-6418
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069256204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC7487OtherMCARE'S PROVIDER NUMBER
MI129802OtherCARE CHOICES PROVIDER NO.
MI0N14730OtherHAP HMO PROVIDER NUMBER
MI000000002038OtherCAPE PIN NUMBER
MI000000002038OtherCAPE PIN NUMBER
MIC7487OtherMCARE'S PROVIDER NUMBER