Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901017088 | MI |
NPI | 1205938503 |
---|---|
Provider Name | Dr. Jeffrey Chaffin |
First Address | Stafford, VA 22554-7612 |
Second Address | Falls Church, VA 22041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |