Provider Demographics
NPI:1588662316
Name:COHEN, MARK EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
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 1:10076 DARNESTOWN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3363
Mailing Address - Country:US
Mailing Address - Phone:301-340-7433
Mailing Address - Fax:301-340-0267
Practice Address - Street 1:10076 DARNESTOWN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3363
Practice Address - Country:US
Practice Address - Phone:301-340-7433
Practice Address - Fax:301-340-0267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD57621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice