Provider Demographics
NPI:1568688208
Name:GRIFFIN, JEFF E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:E
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82959
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-2959
Mailing Address - Country:US
Mailing Address - Phone:225-767-8084
Mailing Address - Fax:225-761-8106
Practice Address - Street 1:13234 PERKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2031
Practice Address - Country:US
Practice Address - Phone:225-767-8084
Practice Address - Fax:225-761-8106
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44251223G0001X
TN86311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice