Provider Demographics
NPI:1861734774
Name:GRIFFITH, THOMAS MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATTHEW
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 1:2530 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5613
Mailing Address - Country:US
Mailing Address - Phone:253-314-7885
Mailing Address - Fax:
Practice Address - Street 1:2530 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5613
Practice Address - Country:US
Practice Address - Phone:253-314-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 603332711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry