Healthcare Provider Details

I. General information

NPI: 1699034017
Provider Name (Legal Business Name): ERIC PHELPS, DDS, MS AND JASON COHEN, DDS, N
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 FOREST AVE. STE. 2
SAN JOSE CA
95128-4812
US

IV. Provider business mailing address

2075 FOREST AVE. STE. 2
SAN JOSE CA
95128-4812
US

V. Phone/Fax

Practice location:
  • Phone: 408-298-3433
  • Fax: 408-298-3433
Mailing address:
  • Phone: 408-298-3433
  • Fax: 408-298-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON COHEN MICHAEL COHEN
Title or Position: DOCTOR/OWNER
Credential: D.D.S., M.S.
Phone: 408-298-3433