Provider Demographics
NPI:1710247408
Name:COHEN, JESSICA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:COHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3532
Mailing Address - Country:US
Mailing Address - Phone:224-427-6800
Mailing Address - Fax:224-385-0040
Practice Address - Street 1:1775 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3532
Practice Address - Country:US
Practice Address - Phone:224-427-6800
Practice Address - Fax:224-385-0040
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210024651223X0400X
IL019028958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist