Healthcare Provider Details

I. General information

NPI: 1588662316
Provider Name (Legal Business Name): MARK EDWARD COHEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10076 DARNESTOWN RD SUITE 100
ROCKVILLE MD
20850-3363
US

IV. Provider business mailing address

10076 DARNESTOWN RD SUITE 100
ROCKVILLE MD
20850-3363
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-7433
  • Fax: 301-340-0267
Mailing address:
  • Phone: 301-340-7433
  • Fax: 301-340-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5762
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: