Provider Demographics
NPI:1508873837
Name:COHEN, STEPHEN D (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2311
Mailing Address - Country:US
Mailing Address - Phone:215-925-6252
Mailing Address - Fax:215-925-6253
Practice Address - Street 1:607 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2311
Practice Address - Country:US
Practice Address - Phone:215-925-6252
Practice Address - Fax:215-925-6253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0174051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry