Provider Demographics
NPI:1851573505
Name:DR. RODNEY B. GRIFFITH
Entity Type:Organization
Organization Name:DR. RODNEY B. GRIFFITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-666-2966
Mailing Address - Street 1:1462 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-9404
Mailing Address - Country:US
Mailing Address - Phone:606-666-2966
Mailing Address - Fax:606-666-7526
Practice Address - Street 1:1462 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-9404
Practice Address - Country:US
Practice Address - Phone:606-666-2966
Practice Address - Fax:606-666-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1164649836Medicare PIN