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General NPI Number Information
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NPI Number | 1104239094
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Entity Type | Organization
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Legal Business Name | BRYAN A. GRIFFITH, DMD, PSC
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 306 WRIGHTS LN
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1702
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Country | US
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Telephone | 606-874-9311
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Fax | 606-874-9828
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Provider Business Mailing Address
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Address Line | 306 WRIGHTS LN
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1702
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Country | US
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Telephone | 606-874-9311
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Fax | 606-874-9828
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Authorized Official
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Title or Position | DENTIST, PRESIDENT
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Name | DR. BRYAN A GRIFFITH
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Credential | DMD
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Telephone | 606-874-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9457
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License Number State | KY
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