MEDICARE: DR. DENISE PAULA GRIFFON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	OH16391	OH

General Provider Information

NPI Number	:	1538126198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE PAULA GRIFFON D.D.S.

Provider Business Mailing Address
First Line	:	1475 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2629
Country	:	US
Telephone Number	:	419-756-1090
Fax Number	:	419-756-8857

Provider Business Practice Location Address
First Line	:	1475 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2629
Country	:	US
Telephone Number	:	419-756-1090
Fax Number	:	419-756-8857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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