Provider Demographics
NPI:1942562558
Name:GRIFFITH, DENNIS BRANDON
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:BRANDON
Last Name:GRIFFITH
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 1:213 S MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1574
Mailing Address - Country:US
Mailing Address - Phone:859-553-5883
Mailing Address - Fax:859-308-1156
Practice Address - Street 1:213 S MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1574
Practice Address - Country:US
Practice Address - Phone:859-553-5883
Practice Address - Fax:859-308-1156
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services