Organization
GRIFFIN ORTHODONTICS PC
Active
Parent organization
IVORY DENTAL SPECIALIST LLC
Other names
ivory dental specialist llc
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVORY DENTAL SPECIALIST LLC
Authorized official
DR. BONCIEL GRIFFIN DDS (ORTHODONTIST/OWNER)
(773) 239-7696
Entity
Organization
Contact information
Practice address
1040 E 47TH STREET, CHICAGO, IL 60653
(773) 239-7696
Mailing address
1040 E 47TH ST, CHICAGO, IL 60653-3600
(773) 924-5123
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019025726
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
021002361
IL
Other
Enumeration date
10/02/2013
Last updated
10/02/2013
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