Organization
JACK D. GRIFFIN, JR. D.M.D., LAKE ST. LOUIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK GRIFFIN JR. DMD (OWNER)
(314) 488-1201
Entity
Organization
Contact information
Practice address
1000 LAKE SAINT LOUIS BLVD, LAKE ST LOUIS, MO 63367-1340
(314) 488-1201
Mailing address
336 BARN SIDE LN, EUREKA, MO 63025-1650
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
014900
MO
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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