Provider Demographics
NPI: | 1760762421 |
---|---|
Name: | C COHEN DENTAL GROUP, INC |
Entity type: | Organization |
Organization Name: | C COHEN DENTAL GROUP, INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CATREEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COHEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 310-429-6786 |
Mailing Address - Street 1: | 269 S BEVERLY DR # 468 |
Mailing Address - Street 2: | |
Mailing Address - City: | BEVERLY HILLS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90212-3851 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 213-484-2186 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1919 W 7TH ST UNIT B |
Practice Address - Street 2: | |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90057-4103 |
Practice Address - Country: | US |
Practice Address - Phone: | 213-484-2186 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-08-25 |
Last Update Date: | 2012-06-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 49861 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |