Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN21746 | FL |
NPI | 1083032742 |
---|---|
Provider Name | Mr. Jad Jaffal |
First Address | The Villages, FL 32162 |
Second Address | The Villages, FL 32162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 15/07/2021 |