Provider Demographics
NPI:1265607865
Name:DR,DENNIS JAFFE DENTIST
Entity type:Organization
Organization Name:DR,DENNIS JAFFE DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. DENNIS JAFFE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:404-688-7574
Mailing Address - Street 1:98 BROAD ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3412
Mailing Address - Country:US
Mailing Address - Phone:404-688-7574
Mailing Address - Fax:404-688-7578
Practice Address - Street 1:98 BROAD ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3412
Practice Address - Country:US
Practice Address - Phone:404-688-7574
Practice Address - Fax:404-688-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO78781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty