Provider Demographics
NPI:1730254046
Name:COHEN, STEPHEN R (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
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 1:1793 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2136
Mailing Address - Country:US
Mailing Address - Phone:856-424-7177
Mailing Address - Fax:856-424-0896
Practice Address - Street 1:1793 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2136
Practice Address - Country:US
Practice Address - Phone:856-424-7177
Practice Address - Fax:856-424-0896
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI115391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037110001OtherDME MAC
NJ1052403Medicaid
NJ1052403Medicaid
NJAC9144510OtherDEA
NJ077832APVMedicare ID - Type UnspecifiedMEDICARE
NJC0252946Medicare ID - Type UnspecifiedMEDICARE SUPPLIES