Healthcare Provider Details

I. General information

NPI: 1568560563
Provider Name (Legal Business Name): RANDALL G. COHEN, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FLORAL VALE BLVD
YARDLEY PA
19067-5512
US

IV. Provider business mailing address

501 FLORAL VALE BLVD
YARDLEY PA
19067-5512
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-9985
  • Fax: 215-504-7450
Mailing address:
  • Phone: 215-579-9985
  • Fax: 215-504-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: RANDALL G. COHEN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 215-579-9985