Provider Demographics
NPI:1972523140
Name:JAFFE, JORDAN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:P
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CADY ST.
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-245-2626
Mailing Address - Fax:401-245-7775
Practice Address - Street 1:147 COUNTY RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-4586
Practice Address - Country:US
Practice Address - Phone:401-245-2626
Practice Address - Fax:401-245-7775
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI027791223X0400X
MA206081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI02779OtherLIC #