Provider Demographics
NPI:1710257241
Name:COHEN, SANDRA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
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 1:4700 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6054
Mailing Address - Country:US
Mailing Address - Phone:770-457-1351
Mailing Address - Fax:770-458-0890
Practice Address - Street 1:4700 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6054
Practice Address - Country:US
Practice Address - Phone:770-457-1351
Practice Address - Fax:770-458-0890
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014369122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist