Provider Demographics
NPI:1750364741
Name:COHEN, LARRY S (DDS)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:S
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 1:4949 W IRVING PARK RD
Mailing Address - Street 2:DENTAL TEAM SUITE F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2655
Mailing Address - Country:US
Mailing Address - Phone:773-725-8818
Mailing Address - Fax:773-725-9491
Practice Address - Street 1:4949 W IRVING PARK RD
Practice Address - Street 2:DENTAL TEAM SUITE F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2655
Practice Address - Country:US
Practice Address - Phone:773-725-8818
Practice Address - Fax:773-725-9491
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist