Provider Demographics
NPI:1598860199
Name:SCHAFFZIN, JESSE NOAH (DENTIST MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:NOAH
Last Name:SCHAFFZIN
Suffix:
Gender:M
Credentials:DENTIST MD
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:NOAH
Other - Last Name:SCHAFFZIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2600 PHILMONT AVE #414
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:215-938-7301
Mailing Address - Fax:215-742-4436
Practice Address - Street 1:2600 PHILMONT AVE #414
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-938-7301
Practice Address - Fax:215-742-4436
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168411223G0001X
PADS036477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist