Provider Demographics
NPI:1841303658
Name:LUSTMAN-COHEN DENTAL, LLC
Entity type:Organization
Organization Name:LUSTMAN-COHEN DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-574-9400
Mailing Address - Street 1:621 STEMMERS RUN RD
Mailing Address - Street 2:STE D
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3386
Mailing Address - Country:US
Mailing Address - Phone:410-574-9400
Mailing Address - Fax:410-574-3787
Practice Address - Street 1:621 STEMMERS RUN RD
Practice Address - Street 2:STE D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3386
Practice Address - Country:US
Practice Address - Phone:410-574-9400
Practice Address - Fax:410-574-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD56341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty