Provider Demographics
NPI:1730371618
Name:GERNHOFER, KORY MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:KORY
Middle Name:MATTHEW
Last Name:GERNHOFER
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 1:2204 KEWAUNEE CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2000
Mailing Address - Country:US
Mailing Address - Phone:734-717-9252
Mailing Address - Fax:
Practice Address - Street 1:3525 W OXFORD AVE UNIT G-1
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3112
Practice Address - Country:US
Practice Address - Phone:303-315-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612741223G0001X
CODEN.00204919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice