Healthcare Provider Details

I. General information

NPI: 1548412620
Provider Name (Legal Business Name): VI ORAL SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS SUITE # 201
ST THOMAS VI
00802-2615
US

IV. Provider business mailing address

9149 ESTATE THOMAS SUITE # 201
ST THOMAS VI
00802-2615
US

V. Phone/Fax

Practice location:
  • Phone: 340-777-5950
  • Fax:
Mailing address:
  • Phone: 340-777-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1057
License Number StateVI

VIII. Authorized Official

Name: DR. HORACE GRIFFITH
Title or Position: OWNER
Credential: DDS
Phone: 340-777-5950