MEDICARE: DONALD GARY GRIFFITH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	18076	MA

General Provider Information

NPI Number	:	1063426559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD GARY GRIFFITH DDS

Provider Business Mailing Address
First Line	:	851 MAIN ST #3
Second Line	:	NEVIN PROFESSIONAL BUILDING
City	:	SO WEYMOUTH
State	:	MA
Zip	:	02190-1613
Country	:	US
Telephone Number	:	781-331-0140
Fax Number	:	781-337-4700

Provider Business Practice Location Address
First Line	:	851 MAIN ST #3
Second Line	:	NEVIN PROFESSIONAL BUILDING
City	:	SO WEYMOUTH
State	:	MA
Zip	:	02190-1613
Country	:	US
Telephone Number	:	781-331-0140
Fax Number	:	781-337-4700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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