Provider Demographics
NPI:1619059227
Name:JAFFE, SAM S
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:JAFFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 PARKLAND BLVD
Mailing Address - Street 2:SUITE 100 AMERICAN DENTAL CENTERS
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-446-1555
Mailing Address - Fax:440-446-1990
Practice Address - Street 1:6140 PARKLAND BLVD
Practice Address - Street 2:#100 AMERICAN DENTAL CENTERS
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-446-1555
Practice Address - Fax:440-446-1990
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300149581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice