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General NPI Number Information
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NPI Number | 1932231206
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Entity Type | Organization
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Legal Business Name | COHN DENTAL ASSOCIATES,LLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6025 N GREEN BAY AVE
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City | MILWAUKEE
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State | WI
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Zip | 53209-3811
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Country | US
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Telephone | 414-228-3000
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Fax | 414-228-3002
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Provider Business Mailing Address
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Address Line | 6025 N GREEN BAY AVE
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City | MILWAUKEE
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State | WI
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Zip | 53209-3811
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Country | US
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Telephone | 414-228-3000
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Fax | 414-228-3002
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC PHILLIP COHN
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Credential | DDS
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Telephone | 414-228-3000
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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 | 40003015-015
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4000508-015
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License Number State | WI
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