Provider Demographics
NPI:1699023770
Name:JAFFE, AVERY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:C
Last Name:JAFFE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 S POMPANO PKWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3003
Mailing Address - Country:US
Mailing Address - Phone:954-972-1000
Mailing Address - Fax:954-972-1889
Practice Address - Street 1:3230 DOCKSIDE DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-3729
Practice Address - Country:US
Practice Address - Phone:404-964-0759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics