Provider Demographics
NPI:1730228255
Name:COHN, RACHEL ELAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELAINE
Last Name:COHN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:ELAINE
Other - Last Name:SERLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:421 TOWN PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6714
Mailing Address - Country:US
Mailing Address - Phone:847-215-9191
Mailing Address - Fax:
Practice Address - Street 1:1514 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1314
Practice Address - Country:US
Practice Address - Phone:773-761-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004752Medicaid