MEDICARE: PATRICE NICOLE GRIFFITH DMD

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	3923-17	MS

General Provider Information

NPI Number	:	1942730429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE NICOLE GRIFFITH DMD

Provider Business Mailing Address
First Line	:	5305 BROOKHOLLOW DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-2024
Country	:	US
Telephone Number	:	601-941-2739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1189 E COUNTY LINE RD STE 1010
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-1836
Country	:	US
Telephone Number	:	601-308-2022
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	06/15/2017

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