Provider Demographics
NPI:1083716799
Name:GRIFFITH, MICHELLE N (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:N
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MONTROSE CT APT 86
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6624
Mailing Address - Country:US
Mailing Address - Phone:205-243-3821
Mailing Address - Fax:
Practice Address - Street 1:5412 MONTGOMERY HWY
Practice Address - Street 2:SUITE 3-8
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-983-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938572Medicaid