Healthcare Provider Details

I. General information

NPI: 1982805180
Provider Name (Legal Business Name): JEFFREY RUSSELL JAICKS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W MAIN ST STE 101
NEW ALBANY OH
43054-9225
US

IV. Provider business mailing address

153 W MAIN ST STE 101
NEW ALBANY OH
43054-9225
US

V. Phone/Fax

Practice location:
  • Phone: 614-741-7031
  • Fax: 614-245-4225
Mailing address:
  • Phone: 614-741-7031
  • Fax: 614-245-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21277
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: