Provider Demographics
NPI:1275872426
Name:JOHNNY M. GRIFFIN DDS PC
Entity Type:Organization
Organization Name:JOHNNY M. GRIFFIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:334-274-9861
Mailing Address - Street 1:1401 I85 PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2833
Mailing Address - Country:US
Mailing Address - Phone:334-274-9861
Mailing Address - Fax:334-274-9863
Practice Address - Street 1:1401 I85 PKWY STE D
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2833
Practice Address - Country:US
Practice Address - Phone:334-274-9861
Practice Address - Fax:334-274-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009901290Medicaid