| NPI | 1861530032 |
|---|---|
| Former Name | JESSICA GWEN COHEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13846) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901018372) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2015-08-07 |