Healthcare Provider Details

I. General information

NPI: 1932386851
Provider Name (Legal Business Name): JOSEPH R COHEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 S 83RD AVE STE 104
PHOENIX AZ
85043-7203
US

IV. Provider business mailing address

5835 E STILL CIR
MESA AZ
85206-3618
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-6665
  • Fax: 623-936-6829
Mailing address:
  • Phone: 480-248-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberAZ1607
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberAZ1607
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberAZ1607
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: