Healthcare Provider Details

I. General information

NPI: 1073650198
Provider Name (Legal Business Name): HAROLD J COHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E ELM AVE
HANOVER PA
17331-1813
US

IV. Provider business mailing address

135 E ELM AVE
HANOVER PA
17331-1813
US

V. Phone/Fax

Practice location:
  • Phone: 717-637-4131
  • Fax: 717-637-4453
Mailing address:
  • Phone: 717-637-4131
  • Fax: 717-637-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS018249L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: