Provider Demographics
NPI:1780836106
Name:ST THOMAS ORAL AND FACIAL HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:ST THOMAS ORAL AND FACIAL HEALTHCARE CENTER, LLC
Other - Org Name:ST THOMAS ORAL AND FACIAL HEALTHCARE CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:340-777-5950
Mailing Address - Street 1:9149 ESTATE THOMAS
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2615
Mailing Address - Country:US
Mailing Address - Phone:340-777-5950
Mailing Address - Fax:340-775-4172
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:SUITE # 201
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2615
Practice Address - Country:US
Practice Address - Phone:340-777-5950
Practice Address - Fax:340-775-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1057261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery