MEDICARE: DENTAL HEALTH ASSOCIATES OF STREETSBORO

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	21397	OH

General Provider Information

NPI Number	:	1851519227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH ASSOCIATES OF STREETSBORO

Provider Business Mailing Address
First Line	:	9150 MARKET SQUARE DR
Second Line	:	SUITE 103
City	:	STREETSBORO
State	:	OH
Zip	:	44241-4571
Country	:	US
Telephone Number	:	330-626-9090
Fax Number	:	330-626-9730

Provider Business Practice Location Address
First Line	:	9150 MARKET SQUARE DR
Second Line	:	SUITE 103
City	:	STREETSBORO
State	:	OH
Zip	:	44241-4571
Country	:	US
Telephone Number	:	330-626-9090
Fax Number	:	330-626-9730

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARVIN COHEN
Credential	:	D.D.S.
Telephone Number	:	330-864-9090

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/22/2020

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