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NPI Code Detail

MEDICARE: DR. KORY MATTHEW GERNHOFER DDS

MEDICARE: DR. KORY MATTHEW GERNHOFER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry61274CA
2122300000XDentistDEN.00204919CO

General Provider Information

NPI Number : 1730371618
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KORY MATTHEW GERNHOFER DDS
Provider Business Mailing Address
First Line : 2204 KEWAUNEE CT
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2000
Country : US
Telephone Number : 734-717-9252
Fax Number :
Provider Business Practice Location Address
First Line : 3525 W OXFORD AVE UNIT G-1
Second Line :
City : DENVER
State : CO
Zip : 80236-3112
Country : US
Telephone Number : 303-315-6150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 10/26/2021

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