Provider Demographics
NPI:1912002197
Name:GRIGGS, EDWARD NICHOLAS III (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:NICHOLAS
Last Name:GRIGGS
Suffix:III
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:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-0579
Mailing Address - Country:US
Mailing Address - Phone:757-787-8218
Mailing Address - Fax:
Practice Address - Street 1:5219 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:NEW CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23415-3332
Practice Address - Country:US
Practice Address - Phone:757-824-5676
Practice Address - Fax:757-824-5872
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9182020Medicaid