MEDICARE: DR. BLAIR ELIZABETH COHEN 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	122300000X	Dentist	3788	AR
2	122300000X	Dentist	9409	TN

General Provider Information

NPI Number	:	1467767301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR ELIZABETH COHEN D.D.S.

Provider Business Mailing Address
First Line	:	735 E BROADWAY BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-4907
Country	:	US
Telephone Number	:	865-475-7901
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 E BROADWAY BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-4907
Country	:	US
Telephone Number	:	865-475-7901
Fax Number	:

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

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	02/23/2023

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