MEDICARE: DR. RYAN THOMAS GRIFFITH 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	1223G0001X	General Practice Dentistry	11342	NC
2	1223G0001X	General Practice Dentistry	DGD.8369 GD	SC

General Provider Information

NPI Number	:	1821401852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN THOMAS GRIFFITH DMD

Provider Business Mailing Address
First Line	:	615 SAINT MARYS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1703
Country	:	US
Telephone Number	:	919-755-3450
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 SAINT MARYS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1703
Country	:	US
Telephone Number	:	919-755-3450
Fax Number	:

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

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	12/22/2020

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