Healthcare Provider Details

I. General information

NPI: 1528154069
Provider Name (Legal Business Name): KOFFI L KOUADIO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KOFFI-BECANTY KOUADIO DDS

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S STERLING ST
MORGANTON NC
28655-3938
US

IV. Provider business mailing address

1000 S STERLING ST
MORGANTON NC
28655-3938
US

V. Phone/Fax

Practice location:
  • Phone: 828-608-4155
  • Fax:
Mailing address:
  • Phone: 828-275-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: