Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12010527 | IN |
NPI | 1003835489 |
---|---|
Provider Name | Dr. Richard Cohen |
First Address | South Bend, IN 46617-2818 |
Second Address | South Bend, IN 46617-2818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 09/07/2007 |