Provider Demographics
NPI:1518934652
Name:GRIFFIN, RANDALL G (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:G
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 1:529 W KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:FLOYDADA
Mailing Address - State:TX
Mailing Address - Zip Code:79235-3221
Mailing Address - Country:US
Mailing Address - Phone:806-790-9732
Mailing Address - Fax:
Practice Address - Street 1:697 LOUISIANA DR
Practice Address - Street 2:7 ADOS/SGGD
Practice Address - City:DYESS AFB
Practice Address - State:TX
Practice Address - Zip Code:79607
Practice Address - Country:US
Practice Address - Phone:325-696-2304
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice