Provider Demographics
NPI:1992861033
Name:KOFORD, JODI L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:KOFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7210 E ORCHARD GRASS BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8559
Mailing Address - Country:US
Mailing Address - Phone:502-243-3177
Mailing Address - Fax:
Practice Address - Street 1:2813 N HURSTBOURNE PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1251
Practice Address - Country:US
Practice Address - Phone:502-326-0011
Practice Address - Fax:502-326-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY69491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics