Provider Demographics
NPI:1730272568
Name:GRIFFITH, BRYAN ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ALAN
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WRIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1702
Mailing Address - Country:US
Mailing Address - Phone:606-874-9311
Mailing Address - Fax:606-874-9828
Practice Address - Street 1:306 WRIGHTS LN
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1702
Practice Address - Country:US
Practice Address - Phone:606-874-9311
Practice Address - Fax:606-874-9828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60067840Medicaid