Healthcare Provider Details

I. General information

NPI: 1497728380
Provider Name (Legal Business Name): BRIAN H COHEN D.D.S..,M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 MONROE ST
DEARBORN MI
48124-2943
US

IV. Provider business mailing address

2120 MONROE ST
DEARBORN MI
48124-2943
US

V. Phone/Fax

Practice location:
  • Phone: 313-562-5800
  • Fax: 313-562-6418
Mailing address:
  • Phone: 313-562-5800
  • Fax: 313-562-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4301069256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: