Provider Demographics
NPI:1508464389
Name:GRIFFITH, TEAH LEE
Entity Type:Individual
Prefix:
First Name:TEAH
Middle Name:LEE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 COUNTY ROUTE 24
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-3330
Mailing Address - Country:US
Mailing Address - Phone:315-489-0495
Mailing Address - Fax:
Practice Address - Street 1:1182 COUNTY ROUTE 24
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-3330
Practice Address - Country:US
Practice Address - Phone:315-489-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030493-01124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist