Healthcare Provider Details

I. General information

NPI: 1790474468
Provider Name (Legal Business Name): ZACHARY STEVEN GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GODWIN DR
WILLIAMSTON NC
27892-6827
US

IV. Provider business mailing address

1060 GODWIN DR
WILLIAMSTON NC
27892-6827
US

V. Phone/Fax

Practice location:
  • Phone: 252-792-1101
  • Fax: 252-792-1102
Mailing address:
  • Phone: 252-792-1101
  • Fax: 252-792-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: