Provider Demographics
NPI:1609941178
Name:GRIFFIN, INA LAURIE (DMD)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:LAURIE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S FREMONT AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-0601
Mailing Address - Country:US
Mailing Address - Phone:985-630-1418
Mailing Address - Fax:
Practice Address - Street 1:650 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:401-706-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23852122300000X
MS084-841223E0200X
MS1928-81122300000X
LA4675122300000X, 1223E0200X
GA013262122300000X
FLDN238521223E0200X
MD17079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics