Healthcare Provider Details

I. General information

NPI: 1205938503
Provider Name (Legal Business Name): JEFFREY CHAFFIN DDS, MPH, MBA, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 LEESBURG PIKE SUITE 682 OFFICE OF THE SURGEON GNERAL, DASG-DC
FALLS CHURCH VA
22041
US

IV. Provider business mailing address

7 SCOTLAND CIR
STAFFORD VA
22554-7612
US

V. Phone/Fax

Practice location:
  • Phone: 703-681-3031
  • Fax:
Mailing address:
  • Phone: 989-659-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901017088
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: