Provider Demographics
NPI:1215092846
Name:GRIFFING, RUSSELL L (DMD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:L
Last Name:GRIFFING
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 1:2611 AVALON COURT
Mailing Address - Street 2:APT A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103
Mailing Address - Country:US
Mailing Address - Phone:270-843-8304
Mailing Address - Fax:
Practice Address - Street 1:727 31W BYPASS
Practice Address - Street 2:SUITE 105C
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-782-9414
Practice Address - Fax:270-781-9093
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice