Healthcare Provider Details

I. General information

NPI: 1841371804
Provider Name (Legal Business Name): MITCHELL S COHEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1111
US

IV. Provider business mailing address

225 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1111
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-2132
  • Fax: 570-343-4340
Mailing address:
  • Phone: 570-346-2132
  • Fax: 570-343-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS026454L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: