Healthcare Provider Details

I. General information

NPI: 1487714812
Provider Name (Legal Business Name): CARL COHEN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE SUITE 405
WORCESTER MA
01609-1989
US

IV. Provider business mailing address

255 PARK AVE SUITE 405
WORCESTER MA
01609-1989
US

V. Phone/Fax

Practice location:
  • Phone: 505-754-6566
  • Fax: 508-757-8866
Mailing address:
  • Phone: 505-754-6566
  • Fax: 508-757-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL COHEN
Title or Position: PRESIDENT OWNER
Credential: DMD
Phone: 508-754-6566