Provider Demographics
NPI:1851494314
Name:COHEN, LEE IRWIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:IRWIN
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 1:969 WINDY HILL RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-433-2555
Mailing Address - Fax:770-436-1889
Practice Address - Street 1:969 WINDY HILL RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-433-2555
Practice Address - Fax:770-436-1889
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist