Healthcare Provider Details

I. General information

NPI: 1619595824
Provider Name (Legal Business Name): WILLIAM DENNIS GRIFFITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

IV. Provider business mailing address

207 S WESTERN AVE
SPRINGFIELD OH
45506-1343
US

V. Phone/Fax

Practice location:
  • Phone: 937-561-1960
  • Fax:
Mailing address:
  • Phone: 937-561-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.386689
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: