1154497014 NPI number — DR. ALKA VISHNU COHEN DDS MS

Table of content: DR. ALKA VISHNU COHEN DDS MS (NPI 1154497014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154497014 NPI number — DR. ALKA VISHNU COHEN DDS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
ALKA
Provider Middle Name:
VISHNU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIR VADHAVKAR
Provider Other First Name:
ALKA
Provider Other Middle Name:
VISHNU
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154497014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8142 COUNTRY VILLAGE DRIVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-756-4447
Provider Business Mailing Address Fax Number:
901-756-8784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8142 COUNTRY VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-756-4447
Provider Business Practice Location Address Fax Number:
901-756-8784
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  TNDS4749 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3207374 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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