Healthcare Provider Details

I. General information

NPI: 1023697836
Provider Name (Legal Business Name): G. ABRAMS AND R. COHEN XX, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 PROVIDENCE RD S
WAXHAW NC
28173-0424
US

IV. Provider business mailing address

1619 PROVIDENCE RD S
WAXHAW NC
28173-0424
US

V. Phone/Fax

Practice location:
  • Phone: 704-246-8971
  • Fax:
Mailing address:
  • Phone: 704-246-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEFF COHEN
Title or Position: COO
Credential:
Phone: 704-246-8971