Provider Demographics
NPI:1932298338
Name:GRIFFITH COSMETIC & FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:GRIFFITH COSMETIC & FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-354-5353
Mailing Address - Street 1:6360 PINE RIDGE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3907
Mailing Address - Country:US
Mailing Address - Phone:239-354-5353
Mailing Address - Fax:239-354-5354
Practice Address - Street 1:6360 PINE RIDGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3907
Practice Address - Country:US
Practice Address - Phone:239-354-5353
Practice Address - Fax:239-354-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15292261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFED TAX ID