Provider Demographics
NPI:1376216598
Name:GRIFFIN, TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:GRIFFIN
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 1:3052 N EASTMAN RD # SITE108
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5005
Mailing Address - Country:US
Mailing Address - Phone:903-663-6900
Mailing Address - Fax:
Practice Address - Street 1:5 EUREKA CIR STE A
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2900
Practice Address - Country:US
Practice Address - Phone:940-691-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373371223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherNOT APPLICABLE