MEDICARE: DR. RANDY W GRIFFIN DMD

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	1223E0200X	Endodontics	9440	FL

General Provider Information

NPI Number	:	1770641797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY W GRIFFIN DMD

Provider Business Mailing Address
First Line	:	2654 W LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3120
Country	:	US
Telephone Number	:	727-787-4005
Fax Number	:	727-786-8740

Provider Business Practice Location Address
First Line	:	2654 W LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3120
Country	:	US
Telephone Number	:	727-787-4005
Fax Number	:	727-786-8740

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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