Provider Demographics
NPI:1700802386
Name:KENNETH A. COHEN AND ANN S. JAMIESON,DDS,PA
Entity Type:Organization
Organization Name:KENNETH A. COHEN AND ANN S. JAMIESON,DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOULISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-855-1007
Mailing Address - Street 1:190 PINE AVE N
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4629
Mailing Address - Country:US
Mailing Address - Phone:813-855-1007
Mailing Address - Fax:813-855-1009
Practice Address - Street 1:190 PINE AVE N
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4629
Practice Address - Country:US
Practice Address - Phone:813-855-1007
Practice Address - Fax:813-855-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102641223G0001X
FL100761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60538OtherBLUE CROSS BLUE SHIELD PR
FL67155OtherBLUE CROSS BLUE SHIELD PR