Healthcare Provider Details

I. General information

NPI: 1013533397
Provider Name (Legal Business Name): ZACHARY JAMES KOFOS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 02/26/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CROWN COLONY DR, STE 205
BOSTON MA
02115-5819
US

IV. Provider business mailing address

240 DEVONSHIRE ST UNIT 4501
BOSTON MA
02110-2172
US

V. Phone/Fax

Practice location:
  • Phone: 617-982-2501
  • Fax:
Mailing address:
  • Phone: 617-678-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858787
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: