MEDICARE: JEFFREY M. 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	1223G0001X	General Practice Dentistry	38174	CA

General Provider Information

NPI Number	:	1487613782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M. COHEN D.D.S.

Provider Business Mailing Address
First Line	:	3410 N LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2915
Country	:	US
Telephone Number	:	562-420-3158
Fax Number	:	562-420-2957

Provider Business Practice Location Address
First Line	:	3410 N LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2915
Country	:	US
Telephone Number	:	562-420-3158
Fax Number	:	562-420-2957

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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