Provider Demographics
NPI:1346537958
Name:GRIFFITH, AUSTIN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:P
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 CONTRA COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8105
Mailing Address - Country:US
Mailing Address - Phone:170-747-7633
Mailing Address - Fax:
Practice Address - Street 1:1430 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3631
Practice Address - Country:US
Practice Address - Phone:170-747-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice