MEDICARE: DR. RONALD ALAN COHEN DDS, MSD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12008879	IN

General Provider Information

NPI Number	:	1952313991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD ALAN COHEN DDS, MSD

Provider Business Mailing Address
First Line	:	10211 DUPONT CIRCLE DR W STE A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1625
Country	:	US
Telephone Number	:	260-489-8989
Fax Number	:	260-489-4954

Provider Business Practice Location Address
First Line	:	10211 DUPONT CIRCLE DR W STE A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1625
Country	:	US
Telephone Number	:	260-489-8989
Fax Number	:	260-489-4954

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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