Provider Demographics
NPI:1285099077
Name:GRIFFITH DENTAL LLC
Entity type:Organization
Organization Name:GRIFFITH DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-822-3400
Mailing Address - Street 1:2100 RIVERSIDE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5914
Mailing Address - Country:US
Mailing Address - Phone:770-822-3400
Mailing Address - Fax:770-995-5772
Practice Address - Street 1:2100 RIVERSIDE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5914
Practice Address - Country:US
Practice Address - Phone:770-822-3400
Practice Address - Fax:770-995-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11545261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental