Provider Demographics
NPI:1902007057
Name:COHEN, REBECCA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
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 1:155 WINDERMERE AVE
Mailing Address - Street 2:#1803
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-5800
Mailing Address - Country:US
Mailing Address - Phone:860-454-4190
Mailing Address - Fax:
Practice Address - Street 1:16 GERRARD AVE
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1606
Practice Address - Country:US
Practice Address - Phone:413-732-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20122122300000X
CT009695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist