Healthcare Provider Details

I. General information

NPI: 1457523797
Provider Name (Legal Business Name): DR ALKA V COHEN DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8142 COUNTRY VILLAGE DR SUITE 101
CORDOVA TN
38016-2029
US

IV. Provider business mailing address

8142 COUNTRY VILLAGE DR SUITE 101
CORDOVA TN
38016-2029
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-4447
  • Fax: 901-756-8784
Mailing address:
  • Phone: 901-756-4447
  • Fax: 901-756-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0016004
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerDORAL PROVIDER NUMBER
# 2
Identifier3207374
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: DR. ALKA VISHNU COHEN
Title or Position: PRESIDENT/OWNER/PEDIATRIC DENTIST
Credential: DDS MS
Phone: 901-756-4447