Provider Demographics
NPI:1760669709
Name:R COHEN DDS AND ASSOCIATES PA
Entity Type:Organization
Organization Name:R COHEN DDS AND ASSOCIATES PA
Other - Org Name:FRIENDLY NEIGHBORHOOD DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-786-7007
Mailing Address - Street 1:2482 WONDER DR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6427
Mailing Address - Country:US
Mailing Address - Phone:704-786-7007
Mailing Address - Fax:
Practice Address - Street 1:2482 WONDER DRIVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6427
Practice Address - Country:US
Practice Address - Phone:704-786-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G ABRAMS DMD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75281223G0001X
NC82431223G0001X
NC83291223G0001X
NC83021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909128Medicaid