Provider Demographics
NPI:1609030071
Name:GRIFFIN, NATALIE VICTORIA (DSS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:VICTORIA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 AVERY RANCH BLVD
Mailing Address - Street 2:C-100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3951
Mailing Address - Country:US
Mailing Address - Phone:512-246-7645
Mailing Address - Fax:
Practice Address - Street 1:14900 AVERY RANCH BLVD
Practice Address - Street 2:C-100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-3951
Practice Address - Country:US
Practice Address - Phone:512-246-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist