Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 37403 | CA |
NPI | 1003859489 |
---|---|
Provider Name | Dr. David Cohen |
First Address | Fountain Valley, CA 92708 |
Second Address | Fountain Valley, CA 92708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |