Active NPI
Fred David Griffin Jr., DDS
- Pediatric Dentistry
- Lufkin, TX
National Provider Identifier
1417047986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12443
- Practice address
- 409 West Frank St.
Lufkin, TX 75904 - Phone
- (936) 634-7186
- NPI assigned
- Oct 13, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 12443 | TX | Primary |
Addresses
Primary practice location
409 West Frank St.
Lufkin, TX 75904
Mailing address
714 Pine Valley Dr
Lufkin, TX 75901-7497
Phone (936) 632-1757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12443 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1417047986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 PINE VALLEY DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759017497",
"telephone_number": "936-632-1757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 WEST FRANK ST.",
"city": "LUFKIN",
"state": "TX",
"postal_code": "75904",
"telephone_number": "936-634-7186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIFFIN",
"first_name": "FRED",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "12443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.