Provider Demographics
NPI:1679766794
Name:COHEN, LISA (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14955 SHADY GROVE RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-340-0101
Mailing Address - Fax:301-340-3836
Practice Address - Street 1:14955 SHADY GROVE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-340-0101
Practice Address - Fax:301-340-1689
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140751223S0112X
DCDEN10006301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery