# DR. JEFFREY DAVID COFFMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1407933500
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3582 | WV | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 02/08/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3582 | STATE TAX ID | WV |
| 05 | — | 3810000801 | — | WV |