Provider Demographics
NPI:1992827489
Name:GRIFFITH, RANDALL L I (DDS)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:GRIFFITH
Suffix:I
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 1:153 S FENWAY ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2721
Mailing Address - Country:US
Mailing Address - Phone:307-265-7337
Mailing Address - Fax:307-265-7340
Practice Address - Street 1:153 S FENWAY ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2721
Practice Address - Country:US
Practice Address - Phone:307-265-7337
Practice Address - Fax:307-265-7340
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice