Provider Demographics
NPI:1093902439
Name:GRIFFITH, KRISTY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MARIE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 T BIRD RD
Mailing Address - Street 2:#2
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258
Mailing Address - Country:US
Mailing Address - Phone:507-337-0675
Mailing Address - Fax:
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-2323
Practice Address - Country:US
Practice Address - Phone:507-337-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice