Provider Demographics
NPI:1942730429
Name:GRIFFITH, PATRICE NICOLE (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:NICOLE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 BROOKHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-2024
Mailing Address - Country:US
Mailing Address - Phone:601-941-2739
Mailing Address - Fax:
Practice Address - Street 1:1189 E COUNTY LINE RD STE 1010
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-1836
Practice Address - Country:US
Practice Address - Phone:601-308-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3923-171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice