MEDICARE: CATREEN E COHEN DENTAL CORPORATION

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	122300000X	Dentist	49861	CA

General Provider Information

NPI Number	:	1366847287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATREEN E COHEN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	9188 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1320
Country	:	US
Telephone Number	:	310-276-9966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 W 7TH ST # 2A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4103
Country	:	US
Telephone Number	:	213-484-2186
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CATREEN COHEN
Credential	:	DDS
Telephone Number	:	310-429-6786

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	11/04/2014

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