Provider Demographics
NPI:1386044469
Name:GRIFFIN, KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
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 1:512 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6555
Mailing Address - Country:US
Mailing Address - Phone:843-873-1202
Mailing Address - Fax:843-873-4962
Practice Address - Street 1:512 N PINE ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6555
Practice Address - Country:US
Practice Address - Phone:843-873-1202
Practice Address - Fax:843-873-4962
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9849122300000X
SC88521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist