Provider Demographics
NPI:1891100673
Name:JAFFE, KATIE N (DDS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:N
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 1:703 SIMON AVE
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2264
Mailing Address - Country:US
Mailing Address - Phone:712-792-4375
Mailing Address - Fax:
Practice Address - Street 1:703 SIMON AVE
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2264
Practice Address - Country:US
Practice Address - Phone:712-792-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist