Healthcare Provider Details

I. General information

NPI: 1821175027
Provider Name (Legal Business Name): ANN L. GRIFFEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE DENTAL FACULTY PRACTICE ASSOCIATION INC.
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W 12TH AVE P.O. BOX 182357
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-1472
  • Fax:
Mailing address:
  • Phone: 614-292-1150
  • Fax: 614-292-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30018578
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: