Provider Demographics
NPI:1083032742
Name:JAFFAL, JAD (DMD)
Entity type:Individual
Prefix:MR
First Name:JAD
Middle Name:
Last Name:JAFFAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LAUREL MANOR DRIVE
Mailing Address - Street 2:SUITE 174
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162
Mailing Address - Country:US
Mailing Address - Phone:352-391-5550
Mailing Address - Fax:352-391-1096
Practice Address - Street 1:1950 LAUREL MANOR DRIVE
Practice Address - Street 2:SUITE 174
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-391-5550
Practice Address - Fax:352-391-1096
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN217461223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery