Provider Demographics
NPI:1033167911
Name:GRIFFIES, JOHN MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:GRIFFIES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3314
Mailing Address - Country:US
Mailing Address - Phone:910-848-8580
Mailing Address - Fax:910-878-0579
Practice Address - Street 1:301 BIRCH ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3298
Practice Address - Country:US
Practice Address - Phone:910-878-5796
Practice Address - Fax:910-878-5793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75761223X0400X
TX137471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC971742OtherUNITED CONCORDIA PROVIDER
NC89902Y7Medicaid
NC9020AOtherBLUE CROSS BLUE SHIELD