Provider Demographics
NPI:1942317045
Name:KOFMAN, ELENA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:M
Last Name:KOFMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1227
Mailing Address - Country:US
Mailing Address - Phone:215-782-2048
Mailing Address - Fax:
Practice Address - Street 1:1599 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6113
Practice Address - Country:US
Practice Address - Phone:610-692-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029460L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice