Provider Demographics
NPI:1528211828
Name:STEPHEN R. GRIFFITH, D.M.D., PLLC.
Entity Type:Organization
Organization Name:STEPHEN R. GRIFFITH, D.M.D., PLLC.
Other - Org Name:GRAND CORNER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-735-9151
Mailing Address - Street 1:3707 S GRAND BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2712
Mailing Address - Country:US
Mailing Address - Phone:509-838-2434
Mailing Address - Fax:509-623-1548
Practice Address - Street 1:3707 S GRAND BLVD
Practice Address - Street 2:STE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2712
Practice Address - Country:US
Practice Address - Phone:509-838-2434
Practice Address - Fax:509-623-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5139261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5052477Medicaid