MEDICARE: BENJAMIN MICHAEL GRIFFITHS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	56116499923	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1747389	OTHER	UT	UNITED CONCORDIA

General Provider Information

NPI Number	:	1093828873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MICHAEL GRIFFITHS DDS

Provider Business Mailing Address
First Line	:	108 NORTH 1600 WEST
Second Line	:
City	:	MAPLETON
State	:	UT
Zip	:	84664
Country	:	US
Telephone Number	:	801-491-6844
Fax Number	:	801-491-6044

Provider Business Practice Location Address
First Line	:	108 NORTH 1600 WEST
Second Line	:	MAPLETON FAMILY DENTISTRY
City	:	MAPLETON
State	:	UT
Zip	:	84664
Country	:	US
Telephone Number	:	801-491-6844
Fax Number	:	801-491-6044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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