Provider Demographics
NPI:1124149232
Name:COHEN, JODI L (DDS)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:COHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-0193
Mailing Address - Country:US
Mailing Address - Phone:203-488-6343
Mailing Address - Fax:203-488-6185
Practice Address - Street 1:337 NOTCH HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1826
Practice Address - Country:US
Practice Address - Phone:203-488-6343
Practice Address - Fax:203-488-6185
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice