Provider Demographics
NPI:1437256989
Name:COHEN, RICHARD CRAFT (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CRAFT
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 22ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3401
Mailing Address - Country:US
Mailing Address - Phone:507-993-0256
Mailing Address - Fax:
Practice Address - Street 1:317 SAINT PAUL ST SW
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965-1097
Practice Address - Country:US
Practice Address - Phone:507-765-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010144871223G0001X
MND12379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice