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General NPI Number Information
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NPI Number | 1285099077
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Entity Type | Organization
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Legal Business Name | GRIFFITH DENTAL LLC
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 2100 RIVERSIDE PKWY STE 130
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5914
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Country | US
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Telephone | 770-822-3400
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Fax | 770-995-5772
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Provider Business Mailing Address
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Address Line | 2100 RIVERSIDE PKWY STE 130
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5914
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Country | US
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Telephone | 770-822-3400
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Fax | 770-995-5772
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JAMES LAWSON GRIFFITH
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Credential | DDS
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Telephone | 770-822-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 11545
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License Number State | GA
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