=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164649836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODNEY BRIAN GRIFFITH D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 08/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1462 HIGHWAY 15 N
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41339-9404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-666-2966
-----------------------------------------------------
Fax | 606-666-7526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1462 HIGHWAY 15 N
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41339-9404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-666-2966
-----------------------------------------------------
Fax | 606-666-7526
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6788
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------