MEDICARE: BLAIR E. COHEN DDS, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396444865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAIR E. COHEN DDS, PLLC

Provider Business Mailing Address
First Line	:	735 E BROADWAY BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-4907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 E BROADWAY BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-4907
Country	:	US
Telephone Number	:	865-475-7901
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BLAIR ELIZABETH COHEN
Credential	:	DDS
Telephone Number	:	865-475-7901

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	02/23/2023

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