Provider Demographics
NPI:1033680145
Name:GRIFFIN, DENNIS LAMONT
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LAMONT
Last Name:GRIFFIN
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 1:507 S CHILSON ST BAY CITY
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4540
Mailing Address - Country:US
Mailing Address - Phone:989-770-2060
Mailing Address - Fax:989-778-2006
Practice Address - Street 1:507 S CHILSON ST BAY CITY
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4540
Practice Address - Country:US
Practice Address - Phone:989-770-2060
Practice Address - Fax:989-778-2006
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5802000055344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG615139488310Medicaid