Provider Demographics
NPI:1083875447
Name:BARRY R. JAFFEDDS,INC
Entity Type:Organization
Organization Name:BARRY R. JAFFEDDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-845-0700
Mailing Address - Street 1:6285 PEARL RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3070
Mailing Address - Country:US
Mailing Address - Phone:440-845-0700
Mailing Address - Fax:440-845-9855
Practice Address - Street 1:6285 PEARL RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3070
Practice Address - Country:US
Practice Address - Phone:440-845-0700
Practice Address - Fax:440-845-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0136851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0159420Medicaid