Healthcare Provider Details

I. General information

NPI: 1245360643
Provider Name (Legal Business Name): GRIFFIN FAMILY COSMETIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13596 HWY 231-431 NORTH SUITE 6
HAZEL GREEN AL
39750
US

IV. Provider business mailing address

13596 HWY 231-431 NORTH SUITE 6
HAZEL GREEN AL
39750
US

V. Phone/Fax

Practice location:
  • Phone: 256-828-8980
  • Fax: 256-828-8668
Mailing address:
  • Phone: 256-828-8980
  • Fax: 256-828-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4845
License Number StateAL

VIII. Authorized Official

Name: WILLIAM JOSEPH GRIFFIN JR.
Title or Position: DMD
Credential: DMD
Phone: 256-828-8980