Provider Demographics
NPI:1922676238
Name:GRIFFITH, JOHN AUSTIN WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN AUSTIN
Middle Name:WILLIAM
Last Name:GRIFFITH
Suffix:
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 1:711 E CLOUD AVE APT 605
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8930
Mailing Address - Country:US
Mailing Address - Phone:316-613-9021
Mailing Address - Fax:
Practice Address - Street 1:2222 N GREENWICH RD STE 400
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8252
Practice Address - Country:US
Practice Address - Phone:316-252-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS618341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice