Provider Demographics
NPI:1255370565
Name:COHEN, MARK INMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:INMAN
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 BEAVER RUIN RD NW
Mailing Address - Street 2:SUITE E
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3401
Mailing Address - Country:US
Mailing Address - Phone:770-717-5552
Mailing Address - Fax:770-279-7916
Practice Address - Street 1:609 BEAVER RUIN RD NW
Practice Address - Street 2:SUITE E
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3401
Practice Address - Country:US
Practice Address - Phone:770-717-5552
Practice Address - Fax:770-279-7916
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics