Provider Demographics
NPI:1255439238
Name:COHEN, RANDALL G (DDS)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:G
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 1:501 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5512
Mailing Address - Country:US
Mailing Address - Phone:215-579-9985
Mailing Address - Fax:215-504-7450
Practice Address - Street 1:501 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5512
Practice Address - Country:US
Practice Address - Phone:215-579-9985
Practice Address - Fax:215-504-7450
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022893L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice