Provider Demographics
NPI:1558145243
Name:COHEN-URDANETA PLLC
Entity Type:Organization
Organization Name:COHEN-URDANETA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-793-2122
Mailing Address - Street 1:210 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-793-2122
Mailing Address - Fax:508-793-1522
Practice Address - Street 1:210 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-793-2122
Practice Address - Fax:508-793-1522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COHEN-URDANETA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty