Provider Demographics
NPI:1336169085
Name:COHEN, STEVEN LAZARUS (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LAZARUS
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS, MSD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1223 HIGUERA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3145
Mailing Address - Country:US
Mailing Address - Phone:805-541-3411
Mailing Address - Fax:805-541-3792
Practice Address - Street 1:1223 HIGUERA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3145
Practice Address - Country:US
Practice Address - Phone:805-541-3411
Practice Address - Fax:805-541-3792
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics