MEDICARE: RAYMOND A. COHLMIA, DDS, PLLC

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	4867	OK

General Provider Information

NPI Number	:	1770876013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYMOND A. COHLMIA, DDS, PLLC

Provider Business Mailing Address
First Line	:	6120 N DREXEL BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4229
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	:	73112-4229
Country	:	US
Telephone Number	:	405-848-3783
Fax Number	:	405-848-4088

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RAYMOND A. COHLMIA
Credential	:	D.D.S.
Telephone Number	:	405-848-3783

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/19/2011

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