Provider Demographics
NPI:1447470117
Name:GRIGGS, PHILLIP B (DDS)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:B
Last Name:GRIGGS
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 1:10440 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4110
Mailing Address - Country:US
Mailing Address - Phone:818-761-5855
Mailing Address - Fax:818-753-4958
Practice Address - Street 1:10440 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4110
Practice Address - Country:US
Practice Address - Phone:818-761-5855
Practice Address - Fax:818-753-4958
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice