Healthcare Provider Details

I. General information

NPI: 1699853903
Provider Name (Legal Business Name): JAMES BERNARD GRIFFIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE PROVIDENCE HOSPITAL SUITE 006
WASHINGTON DC
20017
US

IV. Provider business mailing address

1160 VARNUM ST NE PROVIDENCE HOSPITAL SUITE 006
WASHINGTON DC
20017
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-7103
  • Fax: 202-635-7145
Mailing address:
  • Phone: 202-269-7103
  • Fax: 202-635-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberOEN5533
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11773
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: