Provider Demographics
NPI:1669425930
Name:JAFFE, BARRY RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:RICHARD
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6285 PEARL RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3070
Mailing Address - Country:US
Mailing Address - Phone:440-845-0700
Mailing Address - Fax:440-845-9855
Practice Address - Street 1:6285 PEARL RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3070
Practice Address - Country:US
Practice Address - Phone:440-845-0700
Practice Address - Fax:440-845-9855
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0136851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0159420Medicaid