Healthcare Provider Details

I. General information

NPI: 1295844918
Provider Name (Legal Business Name): ROBERT ALAN KOFF D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7608 N UNION BLVD SUITE A
COLORADO SPRINGS CO
80920-3886
US

IV. Provider business mailing address

7608 N UNION BLVD SUITE A
COLORADO SPRINGS CO
80920
US

V. Phone/Fax

Practice location:
  • Phone: 719-593-9388
  • Fax:
Mailing address:
  • Phone: 719-593-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5460
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: