1396910550 NPI number — MATTHEW COHLMIA, D.D.S., INC. P.C.

Table of content: (NPI 1396910550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396910550 NPI number — MATTHEW COHLMIA, D.D.S., INC. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW COHLMIA, D.D.S., INC. P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396910550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3727 NW 63RD ST
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-1931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-848-3783
Provider Business Mailing Address Fax Number:
405-848-4088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3727 NW 63RD ST
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-848-3783
Provider Business Practice Location Address Fax Number:
405-848-4088
Provider Enumeration Date:
04/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COHLMIA
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
405-848-3783

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5048 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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