Healthcare Provider Details

I. General information

NPI: 1336168749
Provider Name (Legal Business Name): STEVEN NEAL COHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 POST OFFICE SQ 9TH FLOOR
BOSTON MA
02109-3905
US

IV. Provider business mailing address

3 POST OFFICE SQUARE 9TH FLOOR
BOSTON MA
02109-3932
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-6011
  • Fax: 617-426-4680
Mailing address:
  • Phone: 617-426-6011
  • Fax: 617-426-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12130
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: