MEDICARE: DAVID GRIFFIN

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	1223G0001X	General Practice Dentistry	16052	TX

General Provider Information

NPI Number	:	1275751521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID GRIFFIN

Provider Business Mailing Address
First Line	:	6729 BRIDGE ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76112-0817
Country	:	US
Telephone Number	:	817-451-1192
Fax Number	:

Provider Business Practice Location Address
First Line	:	6729 BRIDGE ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76112-0817
Country	:	US
Telephone Number	:	817-451-1192
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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Directions to “ DAVID GRIFFIN ” Practice Location

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