Provider Demographics
NPI:1609191253
Name:GRIFFITTS, TREVOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:GRIFFITTS
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 1:511 W HANLEY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8995
Mailing Address - Country:US
Mailing Address - Phone:208-667-0824
Mailing Address - Fax:208-667-1216
Practice Address - Street 1:511 W HANLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8995
Practice Address - Country:US
Practice Address - Phone:208-667-0824
Practice Address - Fax:208-667-1216
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4563-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery