Provider Demographics
NPI:1811914757
Name:KOFMAN, ELVIRA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:
Last Name:KOFMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 MOORPARK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1712
Mailing Address - Country:US
Mailing Address - Phone:408-243-8291
Mailing Address - Fax:408-243-0154
Practice Address - Street 1:4110 MOORPARK AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1712
Practice Address - Country:US
Practice Address - Phone:408-243-8291
Practice Address - Fax:408-243-0154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice