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General NPI Number Information
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NPI Number | 1851484760
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Entity Type | Organization
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Legal Business Name | GENE C COHEN
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 15510 OLIVE BLVD SUITE 120
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City | CHESTERFIELD
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State | MO
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Zip | 63017-0710
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Country | US
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Telephone | 636-532-2522
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Fax | 636-532-8282
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Provider Business Mailing Address
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Address Line | 15510 OLIVE BLVD SUITE 120
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City | CHESTERFIELD
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State | MO
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Zip | 63017-0710
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Country | US
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Telephone | 636-532-2522
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Fax | 636-532-8282
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Authorized Official
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Title or Position | DENTIST DOCTOR OF DENTAL SURGERY
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Name | DR. GENE C COHEN
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Credential | DDS
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Telephone | 636-532-2522
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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 | 012278
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License Number State | MO
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