Provider Demographics
NPI:1467574525
Name:MICHAEL C GRIFFIN LTD
Entity Type:Organization
Organization Name:MICHAEL C GRIFFIN LTD
Other - Org Name:NORTHALSTED DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-296-0325
Mailing Address - Street 1:3710 N HALSTED ST
Mailing Address - Street 2:STO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:773-296-0325
Mailing Address - Fax:773-296-0335
Practice Address - Street 1:3710 N HALSTED ST
Practice Address - Street 2:STO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613
Practice Address - Country:US
Practice Address - Phone:773-296-0325
Practice Address - Fax:773-296-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty