Provider Demographics
NPI:1528467925
Name:GRIFFITTS FACIAL AND ORAL SURGERY
Entity type:Organization
Organization Name:GRIFFITTS FACIAL AND ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-667-0824
Mailing Address - Street 1:511 W HANLEY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8995
Mailing Address - Country:US
Mailing Address - Phone:208-667-0824
Mailing Address - Fax:208-667-1216
Practice Address - Street 1:511 W HANLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8995
Practice Address - Country:US
Practice Address - Phone:208-667-0824
Practice Address - Fax:208-667-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4563-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty