Provider Demographics
NPI:1770759722
Name:COHEN, JASON ADAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ADAM
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:A
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:#560
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-656-1201
Mailing Address - Fax:301-656-4133
Practice Address - Street 1:5530 WISCONSIN AVENUE
Practice Address - Street 2:SUITE 560
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-656-1201
Practice Address - Fax:301-656-4133
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD13010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist