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General NPI Number Information
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NPI Number | 1558634808
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Entity Type | Organization
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Legal Business Name | DR. JERRY E. COHRON PLLC
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 948 ELM ST SUITE 2
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City | BOWLING GREEN
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State | KY
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Zip | 42101-2277
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Country | US
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Telephone | 270-745-0698
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Fax | 270-745-0067
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Provider Business Mailing Address
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Address Line | 948 ELM ST SUITE 2
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City | BOWLING GREEN
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State | KY
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Zip | 42101-2277
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Country | US
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Telephone | 270-745-0698
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Fax | 270-745-0067
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ELISHA D SMITH
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Credential |
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Telephone | 270-745-0698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4043
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4043
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License Number State | KY
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