Healthcare Provider Details

I. General information

NPI: 1972897395
Provider Name (Legal Business Name): SHELDON C COHEN DMD PC DBA PREMIER DENTAL PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MCBRIDE AND SON CENTER DR SUITE 203
CHESTERFIELD MO
63005-1418
US

IV. Provider business mailing address

6 MCBRIDE AND SON CENTER DR SUITE 203
CHESTERFIELD MO
63005-1418
US

V. Phone/Fax

Practice location:
  • Phone: 636-728-1199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA ANDREATTA
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 314-361-0760