Provider Demographics
NPI:1336589134
Name:GRIFFIN, CAROLYN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:STRASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1720 E LAKE BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1563
Mailing Address - Country:US
Mailing Address - Phone:414-962-1800
Mailing Address - Fax:
Practice Address - Street 1:1720 E LAKE BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1563
Practice Address - Country:US
Practice Address - Phone:414-962-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7054-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist