Provider Demographics
NPI:1649509670
Name:GRIFFITH, JEFF J (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:J
Last Name:GRIFFITH
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 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-2323
Mailing Address - Country:US
Mailing Address - Phone:320-685-3564
Mailing Address - Fax:320-685-3961
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-2323
Practice Address - Country:US
Practice Address - Phone:320-685-3564
Practice Address - Fax:320-685-3961
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice