Organization
GRIFFIN ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BONCIEL LATRICE GRIFFIN DDS (ORTHODONTIST)
(773) 239-7696
Entity
Organization
Contact information
Practice address
10019 S WESTERN AVE, CHICAGO, IL 60643-1925
(773) 239-7696
Mailing address
10019 S WESTERN AVE, CHICAGO, IL 60643-1925
(773) 239-7696
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021002361
IL
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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