Provider Demographics
NPI:1467817254
Name:KOFFORD, JONES, INGERSOLL & SMITH, DDS PLLC
Entity Type:Organization
Organization Name:KOFFORD, JONES, INGERSOLL & SMITH, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-742-2392
Mailing Address - Street 1:422 N HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3063
Mailing Address - Country:US
Mailing Address - Phone:919-742-2392
Mailing Address - Fax:
Practice Address - Street 1:422 N HOLLY AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3063
Practice Address - Country:US
Practice Address - Phone:919-742-2392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental