Provider Demographics
NPI:1285749515
Name:COHN, VICKI ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ELLEN
Last Name:COHN
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 1:70 WELLS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3233
Mailing Address - Country:US
Mailing Address - Phone:617-964-4028
Mailing Address - Fax:617-595-4591
Practice Address - Street 1:70 WELLS AVE STE 103
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3233
Practice Address - Country:US
Practice Address - Phone:617-964-4028
Practice Address - Fax:617-595-4591
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039271-11223G0001X
MADN22195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice