Provider Demographics
NPI:1740383249
Name:COHEN, MARC D (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-789-0555
Mailing Address - Fax:818-789-5011
Practice Address - Street 1:16311 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 1250
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-789-0555
Practice Address - Fax:818-789-5011
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice