Provider Demographics
NPI:1508549437
Name:GRIFFIN, EDWARD LEAR
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEAR
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 1:3960 SHIDER LN
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081
Mailing Address - Country:US
Mailing Address - Phone:704-773-9383
Mailing Address - Fax:
Practice Address - Street 1:4291 SCHOOL HOUSE CMNS
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7503
Practice Address - Country:US
Practice Address - Phone:704-456-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC134171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice