Provider Demographics
NPI:1619998556
Name:KOFSKI, JEROME WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:WILLIAM
Last Name:KOFSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 GENEVA AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5705
Mailing Address - Country:US
Mailing Address - Phone:651-731-2342
Mailing Address - Fax:651-731-7679
Practice Address - Street 1:1253 GENEVA AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5705
Practice Address - Country:US
Practice Address - Phone:651-731-2342
Practice Address - Fax:651-731-7679
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN91591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice