Provider Demographics
NPI:1699034017
Name:ERIC PHELPS, DDS, MS AND JASON COHEN, DDS, N
Entity Type:Organization
Organization Name:ERIC PHELPS, DDS, MS AND JASON COHEN, DDS, N
Other - Org Name:PHELPS & COHEN ORTHODONTICS DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON COHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:408-298-3433
Mailing Address - Street 1:2075 FOREST AVE.
Mailing Address - Street 2:STE. 2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4812
Mailing Address - Country:US
Mailing Address - Phone:408-298-3433
Mailing Address - Fax:408-298-6304
Practice Address - Street 1:2075 FOREST AVE.
Practice Address - Street 2:STE. 2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4812
Practice Address - Country:US
Practice Address - Phone:408-298-3433
Practice Address - Fax:408-298-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty