Provider Demographics
NPI:1659643948
Name:COHEN, GLENN TODD (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:TODD
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 COIT RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7757
Mailing Address - Country:US
Mailing Address - Phone:972-596-4502
Mailing Address - Fax:
Practice Address - Street 1:1220 COIT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7757
Practice Address - Country:US
Practice Address - Phone:972-596-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics