Provider Demographics
NPI:1528148137
Name:COHEN, JASON HEATH (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:HEATH
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 RUTLEDGE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403
Mailing Address - Country:US
Mailing Address - Phone:843-216-2517
Mailing Address - Fax:843-577-2826
Practice Address - Street 1:198 RUTLEDGE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403
Practice Address - Country:US
Practice Address - Phone:843-216-2517
Practice Address - Fax:843-577-2826
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC247451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics