Provider Demographics
NPI:1720472392
Name:BYRON L. COHEE,DDS,PC
Entity Type:Organization
Organization Name:BYRON L. COHEE,DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:COHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-473-5959
Mailing Address - Street 1:65 E 2ND ST
Mailing Address - Street 2:P.O. BOX 11
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2266
Mailing Address - Country:US
Mailing Address - Phone:765-473-5959
Mailing Address - Fax:765-473-7511
Practice Address - Street 1:65 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2266
Practice Address - Country:US
Practice Address - Phone:765-473-5959
Practice Address - Fax:765-473-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ12008206A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100179390AMedicaid