Provider Demographics
NPI:1366644148
Name:GRIFFETH, SPENCER R (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:R
Last Name:GRIFFETH
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 1:175 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1703
Mailing Address - Country:US
Mailing Address - Phone:706-692-2646
Mailing Address - Fax:706-692-5716
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1703
Practice Address - Country:US
Practice Address - Phone:706-692-2646
Practice Address - Fax:706-692-5716
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice