Provider Demographics
NPI:1285228908
Name:BRANDON D KOFFORD DMD AND UDAY N REEBYE DMD PLLC
Entity Type:Organization
Organization Name:BRANDON D KOFFORD DMD AND UDAY N REEBYE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-858-8193
Mailing Address - Street 1:1400 CRESCENT GRN STE 210
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8118
Mailing Address - Country:US
Mailing Address - Phone:919-858-8193
Mailing Address - Fax:
Practice Address - Street 1:1400 CRESCENT GRN STE 210
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8118
Practice Address - Country:US
Practice Address - Phone:919-858-8193
Practice Address - Fax:919-858-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty