Provider Demographics
NPI:1811426810
Name:CAROLYN GRIFFIN DDS LLC
Entity type:Organization
Organization Name:CAROLYN GRIFFIN DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-962-1800
Mailing Address - Street 1:4018 E ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1205
Mailing Address - Country:US
Mailing Address - Phone:262-945-8227
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:53211-1517
Practice Address - Country:US
Practice Address - Phone:414-962-1800
Practice Address - Fax:414-962-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7054-151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty