Individual
GRIFFIN DAVIS PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5656 EDWARDS RANCH RD STE 101, FORT WORTH, TX 76109-4105
(817) 731-9487
Mailing address
5656 EDWARDS RANCH RD STE 101, FORT WORTH, TX 76109-4105
(817) 731-9487
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
33671
TX
122300000X
Dentist
6943
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33671
TEXAS STATE BOARD
TX
Enumeration date
08/23/2017
Last updated
05/06/2025
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