Provider Demographics
NPI:1538253992
Name:GRIFFIN, PHILIP TIM (DDS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:TIM
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PENNY LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6018
Mailing Address - Country:US
Mailing Address - Phone:831-722-8469
Mailing Address - Fax:831-722-0241
Practice Address - Street 1:56 PENNY LN
Practice Address - Street 2:SUITE C
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6018
Practice Address - Country:US
Practice Address - Phone:831-722-8469
Practice Address - Fax:831-722-0241
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice