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General NPI Number Information
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NPI Number | 1730371618
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Entity Type | Individual
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Provider Name | KORY MATTHEW GERNHOFER DDS
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Gender | Male
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 3525 W OXFORD AVE UNIT G-1
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City | DENVER
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State | CO
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Zip | 80236-3112
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Country | US
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Telephone | 303-315-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 2204 KEWAUNEE CT
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-2000
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Country | US
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Telephone | 734-717-9252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61274
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00204919
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License Number State | CO
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