Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 7074787-9921 | UT |
Y | 1223P0700X | Prosthodontist | 9664 | NC |
NPI | 1043455371 |
---|---|
Provider Name | Dr. Brandon Dale Kofford |
First Address | Cary, NC 27518-8118 |
Second Address | Cary, NC 27518-8118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2008 |
Last Update Date | 19/05/2020 |