Provider Demographics
NPI:1235711797
Name:JAFFE, RYAN NEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NEIL
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 N FORK DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3740
Mailing Address - Country:US
Mailing Address - Phone:561-284-5700
Mailing Address - Fax:
Practice Address - Street 1:1566 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4602
Practice Address - Country:US
Practice Address - Phone:407-645-4645
Practice Address - Fax:407-628-3870
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
FLDN25928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program