Healthcare Provider Details

I. General information

NPI: 1336651082
Provider Name (Legal Business Name): COHEN DENTAL STUDIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 2ND AVE N STE 303
NAPLES FL
34102-5702
US

IV. Provider business mailing address

700 2ND AVE N STE 303
NAPLES FL
34102-5702
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-2000
  • Fax: 239-351-1880
Mailing address:
  • Phone: 239-351-2000
  • Fax: 239-351-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN16843
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN20441
License Number StateFL

VIII. Authorized Official

Name: DR. NEIL D COHEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 239-351-2000