Provider Demographics
NPI:1952313991
Name:COHEN, RONALD ALAN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALAN
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 DUPONT CIRCLE DR W STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1625
Mailing Address - Country:US
Mailing Address - Phone:260-489-8989
Mailing Address - Fax:260-489-4954
Practice Address - Street 1:10211 DUPONT CIRCLE DR W STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1625
Practice Address - Country:US
Practice Address - Phone:260-489-8989
Practice Address - Fax:260-489-4954
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics