Provider Demographics
NPI:1770736415
Name:ST CROIX ORAL AND FACIAL HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:ST CROIX ORAL AND FACIAL HEALTHCARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:340-719-3864
Mailing Address - Street 1:RR 2 BOX 10571
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00850-9604
Mailing Address - Country:US
Mailing Address - Phone:340-719-3864
Mailing Address - Fax:340-719-3865
Practice Address - Street 1:RR 2 BOX 10571
Practice Address - Street 2:
Practice Address - City:KINGSHILL
Practice Address - State:VI
Practice Address - Zip Code:00850-9604
Practice Address - Country:US
Practice Address - Phone:340-719-3864
Practice Address - Fax:340-719-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1057261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery