=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851435002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES FLYNN GRIFFITH, DDS, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 TOLLEY DR
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26330-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-842-1995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 TOLLEY DR
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26330-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-842-1995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES FLYNN GRIFFITH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 304-842-1995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2536
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------