Provider Demographics
NPI:1194992586
Name:GRIFFETH, MATTHEW MELVIN (DMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MELVIN
Last Name:GRIFFETH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980367
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-0367
Mailing Address - Country:US
Mailing Address - Phone:435-647-3012
Mailing Address - Fax:435-645-9873
Practice Address - Street 1:1680 UTE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7634
Practice Address - Country:US
Practice Address - Phone:435-647-3012
Practice Address - Fax:435-645-9873
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT618132799221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice