Provider Demographics
NPI:1245360643
Name:GRIFFIN FAMILY COSMETIC DENTISTRY
Entity type:Organization
Organization Name:GRIFFIN FAMILY COSMETIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-828-8980
Mailing Address - Street 1:13596 HWY 231-431 NORTH
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:39750
Mailing Address - Country:US
Mailing Address - Phone:256-828-8980
Mailing Address - Fax:256-828-8668
Practice Address - Street 1:13596 HWY 231-431 NORTH
Practice Address - Street 2:SUITE 6
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:39750
Practice Address - Country:US
Practice Address - Phone:256-828-8980
Practice Address - Fax:256-828-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty