Healthcare Provider Details

I. General information

NPI: 1255589610
Provider Name (Legal Business Name): JENNIFER J GRIFFIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK RD STE 9
CATONSVILLE MD
21228-4607
US

IV. Provider business mailing address

9610 DEWITT DR
SILVER SPRING MD
20910-7110
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-4484
  • Fax:
Mailing address:
  • Phone: 301-588-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN1000961
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401412964
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14626
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: