Provider Demographics
NPI:1104239094
Name:BRYAN A. GRIFFITH, DMD, PSC
Entity type:Organization
Organization Name:BRYAN A. GRIFFITH, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-874-9311
Mailing Address - Street 1:306 WRIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1702
Mailing Address - Country:US
Mailing Address - Phone:606-874-9311
Mailing Address - Fax:606-874-9828
Practice Address - Street 1:306 WRIGHTS LN
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1702
Practice Address - Country:US
Practice Address - Phone:606-874-9311
Practice Address - Fax:606-874-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty