Provider Demographics
NPI:1760660724
Name:J GREG GRIFFIN DDS PA
Entity Type:Organization
Organization Name:J GREG GRIFFIN DDS PA
Other - Org Name:J GREG GRIFFIN DDS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-624-9300
Mailing Address - Street 1:6604 E MARSHVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-1198
Mailing Address - Country:US
Mailing Address - Phone:704-624-9300
Mailing Address - Fax:704-624-0311
Practice Address - Street 1:6604 E MARSHVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1198
Practice Address - Country:US
Practice Address - Phone:704-624-9300
Practice Address - Fax:704-624-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5594OtherDELTA DENTAL