Provider Demographics
NPI:1003811753
Name:DEEN, GRIFFIN LAVELLE JR (DDS)
Entity Type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:LAVELLE
Last Name:DEEN
Suffix:JR
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 1:122 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2814
Mailing Address - Country:US
Mailing Address - Phone:985-867-9122
Mailing Address - Fax:985-867-9169
Practice Address - Street 1:122 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2814
Practice Address - Country:US
Practice Address - Phone:985-867-9122
Practice Address - Fax:985-867-9169
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA2119OtherBLUE CROSS/BLUE SHIELD
TXV04346OtherBLUE CROSS/BLUE SHIELD
LA1843466Medicaid