Healthcare Provider Details

I. General information

NPI: 1467817254
Provider Name (Legal Business Name): KOFFORD, JONES, INGERSOLL & SMITH, DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N HOLLY AVE
SILER CITY NC
27344-3063
US

IV. Provider business mailing address

422 N HOLLY AVE
SILER CITY NC
27344-3063
US

V. Phone/Fax

Practice location:
  • Phone: 919-742-2392
  • Fax:
Mailing address:
  • Phone: 919-742-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAKE RYAN JONES
Title or Position: MEMBER
Credential: DMD
Phone: 919-742-2392