Provider Demographics
NPI:1740663970
Name:HENRY G. GRIGGS, JR., D.M.D.,M.S., LLC
Entity type:Organization
Organization Name:HENRY G. GRIGGS, JR., D.M.D.,M.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:256-216-1717
Mailing Address - Street 1:102 S MALONE ST STE B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2476
Mailing Address - Country:US
Mailing Address - Phone:256-216-1717
Mailing Address - Fax:256-216-1771
Practice Address - Street 1:102 S MALONE ST STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2476
Practice Address - Country:US
Practice Address - Phone:256-216-1717
Practice Address - Fax:256-216-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty