Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 18076 | MA |
NPI | 1063426559 |
---|---|
Provider Name | Donald Gary Griffith |
First Address | So Weymouth, MA 02190-1613 |
Second Address | So Weymouth, MA 02190-1613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |