Individual
GRIFFIN LAVELLE DEEN JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
122 E 21ST AVE, COVINGTON, LA 70433-2814
(985) 867-9122
(985) 867-9169
Mailing address
122 E 21ST AVE, COVINGTON, LA 70433-2814
(985) 867-9122
(985) 867-9169
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4346
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1843466
—
LA
01
—
A2119
BLUE CROSS/BLUE SHIELD
LA
01
—
V04346
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
06/18/2005
Last updated
07/08/2007
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