Provider Demographics
NPI:1568520302
Name:JAFFE, HARVEY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:M
Last Name:JAFFE
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 1:790 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3645
Mailing Address - Country:US
Mailing Address - Phone:440-439-1221
Mailing Address - Fax:440-439-8449
Practice Address - Street 1:790 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3645
Practice Address - Country:US
Practice Address - Phone:440-439-1221
Practice Address - Fax:440-439-8449
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30. 0151621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305842Medicaid