MEDICARE: DR. MATTHEW E. COHLMIA SR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5048	OK

General Provider Information

NPI Number	:	1407976681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW E. COHLMIA SR. D.D.S.

Provider Business Mailing Address
First Line	:	6120 N DREXEL BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4327
Country	:	US
Telephone Number	:	405-848-3783
Fax Number	:	405-848-4088

Provider Business Practice Location Address
First Line	:	6120 N DREXEL BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4327
Country	:	US
Telephone Number	:	405-848-3783
Fax Number	:	405-848-4088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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