Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | AZ1704 | AZ |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS017502L | PA |
NPI | 1467548560 |
---|---|
Provider Name | Dr. David P Griffith |
First Address | Phoenix, AZ 85033 |
Second Address | Phoenix, AZ 85033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 17/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000BGMLJ | (02) | AZ |