Provider Demographics
NPI:1073036109
Name:GRIFFITH, AMY R
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 HOLLENBECK AVE.
Mailing Address - Street 2:#116
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-736-6856
Mailing Address - Fax:408-736-8606
Practice Address - Street 1:1565 HOLLENBECK AVE STE 116
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4300
Practice Address - Country:US
Practice Address - Phone:408-736-6856
Practice Address - Fax:408-736-8606
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1014471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice