=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174653042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI DAWN COHEN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 02/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 285 CENTRAL AVE SUITE F-3
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11559-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-371-6270
-----------------------------------------------------
Fax | 516-371-5648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 285 CENTRAL AVE SUITE F-3
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11559-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-371-6270
-----------------------------------------------------
Fax | 516-371-5648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 046819-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------