Provider Demographics
NPI:1740055177
Name:DICK-COHEN, MIRIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:DICK-COHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:73 REGINA AVE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M6A1R5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1853
Practice Address - Country:US
Practice Address - Phone:518-566-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0634971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice