Provider Demographics
NPI:1174267694
Name:DABBS, GRIFFIN THOMAS
Entity Type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:THOMAS
Last Name:DABBS
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 1:1237 BEACON HILL CT
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5415
Mailing Address - Country:US
Mailing Address - Phone:309-530-8045
Mailing Address - Fax:
Practice Address - Street 1:1237 BEACON HILL CT
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-5415
Practice Address - Country:US
Practice Address - Phone:309-530-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program