Provider Demographics
NPI:1790504041
Name:KENDALLVILLE FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:KENDALLVILLE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-425-8825
Mailing Address - Street 1:111 EAGLE CLIFF CV
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9288
Mailing Address - Country:US
Mailing Address - Phone:248-425-8825
Mailing Address - Fax:
Practice Address - Street 1:1843 IDA RED RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2873
Practice Address - Country:US
Practice Address - Phone:260-343-0568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental