Provider Demographics
NPI:1851303515
Name:KOFF, STEVEN ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:KOFF
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 1:270 LITTLETON RD
Mailing Address - Street 2:UNIT #12
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3526
Mailing Address - Country:US
Mailing Address - Phone:978-692-3051
Mailing Address - Fax:978-692-8875
Practice Address - Street 1:270 LITTLETON RD
Practice Address - Street 2:UNIT #12
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3526
Practice Address - Country:US
Practice Address - Phone:978-692-3051
Practice Address - Fax:978-692-8875
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
990325OtherUNITED CONCORDIA
XO8538OtherBCBS
MA0252352Medicaid