Healthcare Provider Details

I. General information

NPI: 1124080437
Provider Name (Legal Business Name): IRA COHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 MCKEAN AVE
DONORA PA
15033-1002
US

IV. Provider business mailing address

926 GREAT POND DR SUITE 2003
ALTAMONTE SPRINGS FL
32714-7244
US

V. Phone/Fax

Practice location:
  • Phone: 407-772-5124
  • Fax: 407-788-3572
Mailing address:
  • Phone: 407-772-5124
  • Fax: 407-788-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS025536
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: