Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 059105-1 | NY |
Y | 1223P0106X | Oral and Maxillofacial Pathology | DEN4746 | ME |
NPI | 1407142540 |
---|---|
Provider Name | Dr. Molly Dee Cohen |
First Address | Portland, ME 04103-2656 |
Second Address | Portland, ME 04103-2656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 02/10/2019 |