Provider Demographics
NPI:1033319330
Name:DANIEL JAFFE, D.D.S., INC.
Entity Type:Organization
Organization Name:DANIEL JAFFE, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-374-1833
Mailing Address - Street 1:305 ORANGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-8128
Mailing Address - Country:US
Mailing Address - Phone:714-374-1833
Mailing Address - Fax:714-374-0492
Practice Address - Street 1:305 ORANGE AVE STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-8128
Practice Address - Country:US
Practice Address - Phone:714-374-1833
Practice Address - Fax:714-374-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3901501OtherMEDI-CAL PROVIDER NUMBER