Provider Demographics
NPI:1164649836
Name:GRIFFITH, RODNEY BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:BRIAN
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-9404
Mailing Address - Country:US
Mailing Address - Phone:606-666-2966
Mailing Address - Fax:606-666-7526
Practice Address - Street 1:1462 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-9404
Practice Address - Country:US
Practice Address - Phone:606-666-2966
Practice Address - Fax:606-666-7526
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67881223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60067881Medicaid