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General NPI Number Information
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NPI Number | 1851519227
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH ASSOCIATES OF STREETSBORO
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9150 MARKET SQUARE DR SUITE 103
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City | STREETSBORO
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State | OH
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Zip | 44241-4571
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Country | US
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Telephone | 330-626-9090
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Fax | 330-626-9730
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Provider Business Mailing Address
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Address Line | 9150 MARKET SQUARE DR SUITE 103
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City | STREETSBORO
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State | OH
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Zip | 44241-4571
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Country | US
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Telephone | 330-626-9090
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Fax | 330-626-9730
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARVIN COHEN
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Credential | D.D.S.
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Telephone | 330-864-9090
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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 | 21397
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License Number State | OH
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