Provider Demographics
NPI:1477398642
Name:JAFRI, JOSEPH ADAM
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ADAM
Last Name:JAFRI
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 1:1425 N M 52
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1234
Mailing Address - Country:US
Mailing Address - Phone:989-729-1999
Mailing Address - Fax:
Practice Address - Street 1:1425 N M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1234
Practice Address - Country:US
Practice Address - Phone:989-729-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist