Provider Demographics
NPI:1477098440
Name:GRIGGS FAMILY DENTAL LLC
Entity type:Organization
Organization Name:GRIGGS FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-532-3227
Mailing Address - Street 1:241 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2848
Mailing Address - Country:US
Mailing Address - Phone:307-532-3227
Mailing Address - Fax:307-532-3744
Practice Address - Street 1:241 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2848
Practice Address - Country:US
Practice Address - Phone:307-532-3227
Practice Address - Fax:307-532-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106745100Medicaid