Provider Demographics
NPI:1851484760
Name:GENE C COHEN
Entity Type:Organization
Organization Name:GENE C COHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST DOCTOR OF DENTAL SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-532-2522
Mailing Address - Street 1:15510 OLIVE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-0710
Mailing Address - Country:US
Mailing Address - Phone:636-532-2522
Mailing Address - Fax:636-532-8282
Practice Address - Street 1:15510 OLIVE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-0710
Practice Address - Country:US
Practice Address - Phone:636-532-2522
Practice Address - Fax:636-532-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO012278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO223876308OtherTAXID