Healthcare Provider Details

I. General information

NPI: 1871625160
Provider Name (Legal Business Name): GRIFFIN DENTAL P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E WALNUT ST
RIPLEY MS
38663-2113
US

IV. Provider business mailing address

415 E WALNUT ST
RIPLEY MS
38663-2113
US

V. Phone/Fax

Practice location:
  • Phone: 662-837-8141
  • Fax: 662-837-8199
Mailing address:
  • Phone: 662-837-8141
  • Fax: 662-837-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3049-98
License Number StateMS

VIII. Authorized Official

Name: DR. CHRIS GRIFFIN
Title or Position: DOCTOR
Credential: D.D.S.
Phone: 662-837-8141