Provider Demographics
NPI:1245452176
Name:GRISWOLD, MOLLIE ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:ELIZABETH
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MOLLIE
Other - Middle Name:ELIZABETH
Other - Last Name:GRISWOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3315 SPRINGBANK LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-247-1500
Mailing Address - Fax:704-464-4831
Practice Address - Street 1:3315 SPRINGBANK LN
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-247-1500
Practice Address - Fax:704-464-4831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8652122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist