Provider Demographics
NPI:1871764563
Name:DONALD E JAFFE, DMD PC
Entity type:Organization
Organization Name:DONALD E JAFFE, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-993-1728
Mailing Address - Street 1:319 UNION ST # A
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5020
Mailing Address - Country:US
Mailing Address - Phone:508-993-1728
Mailing Address - Fax:508-997-2127
Practice Address - Street 1:319 UNION ST # A
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5020
Practice Address - Country:US
Practice Address - Phone:508-993-1728
Practice Address - Fax:508-997-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0218677Medicaid