Provider Demographics
NPI:1538365853
Name:JAFFE, RICHARD SETH (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SETH
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 1:201 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4911
Mailing Address - Country:US
Mailing Address - Phone:410-288-1162
Mailing Address - Fax:410-288-5757
Practice Address - Street 1:201 WISE AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4911
Practice Address - Country:US
Practice Address - Phone:410-288-1162
Practice Address - Fax:410-288-5757
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD88281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice