MEDICARE: DR. RODNEY BRIAN GRIFFITH D.M.D.

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	1223G0001X	General Practice Dentistry	6788	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164649836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY BRIAN GRIFFITH D.M.D.

Provider Business Mailing Address
First Line	:	1462 HIGHWAY 15 N
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-9404
Country	:	US
Telephone Number	:	606-666-2966
Fax Number	:	606-666-7526

Provider Business Practice Location Address
First Line	:	1462 HIGHWAY 15 N
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-9404
Country	:	US
Telephone Number	:	606-666-2966
Fax Number	:	606-666-7526

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/26/2015

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