Provider Demographics
NPI:1598002982
Name:M. AMIN JAFFER, DDS, PC
Entity Type:Organization
Organization Name:M. AMIN JAFFER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:JAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-292-1792
Mailing Address - Street 1:25507 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1555
Mailing Address - Country:US
Mailing Address - Phone:313-292-1792
Mailing Address - Fax:
Practice Address - Street 1:25507 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1555
Practice Address - Country:US
Practice Address - Phone:313-292-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017194261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental