MEDICARE: JASON M COHEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901017871	MI

General Provider Information

NPI Number	:	1144295924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M COHEN DDS

Provider Business Mailing Address
First Line	:	14420 EUREKA RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195
Country	:	US
Telephone Number	:	734-283-1263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 FORT ST
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-3545
Country	:	US
Telephone Number	:	734-283-1263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	11/06/2015

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