Provider Demographics
NPI:1407012867
Name:GRIFFETH DENTAL PC
Entity type:Organization
Organization Name:GRIFFETH DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFETH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-692-2646
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-0698
Mailing Address - Country:US
Mailing Address - Phone:706-692-2646
Mailing Address - Fax:
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1703
Practice Address - Country:US
Practice Address - Phone:706-692-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty