Provider Demographics
NPI:1710106836
Name:COHEN, GARY MITCHELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MITCHELL
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 SW WOODHAVEN ST.
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990
Mailing Address - Country:US
Mailing Address - Phone:772-341-3565
Mailing Address - Fax:
Practice Address - Street 1:5909 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1333
Practice Address - Country:US
Practice Address - Phone:561-967-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist