Provider Demographics
NPI:1144744731
Name:COFMAN, NICOLAS (DMD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:COFMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 FLORIDA RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4775
Mailing Address - Country:US
Mailing Address - Phone:970-259-0113
Mailing Address - Fax:970-259-5348
Practice Address - Street 1:801 FLORIDA RD UNIT 2
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4775
Practice Address - Country:US
Practice Address - Phone:970-259-0113
Practice Address - Fax:970-259-5348
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2032011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice