Provider Demographics
NPI:1053548842
Name:GRIFFITHS, TY
Entity type:Individual
Prefix:DR
First Name:TY
Middle Name:
Last Name:GRIFFITHS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 TAMIAMI TRL S STE F
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3129
Mailing Address - Country:US
Mailing Address - Phone:941-493-4156
Mailing Address - Fax:941-493-4254
Practice Address - Street 1:1872 TAMIAMI TRL S STE F
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3129
Practice Address - Country:US
Practice Address - Phone:941-493-4156
Practice Address - Fax:941-493-4254
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice