Provider Demographics
NPI:1932284619
Name:GRIFFITH, SCOTT R (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:GRIFFITH
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 1:11839 OAK TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1038
Mailing Address - Country:US
Mailing Address - Phone:727-862-3535
Mailing Address - Fax:727-869-2747
Practice Address - Street 1:11839 OAK TRAIL WAY
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1038
Practice Address - Country:US
Practice Address - Phone:727-862-3535
Practice Address - Fax:727-869-2747
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00148611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice