Provider Demographics
NPI:1487810768
Name:GRIFFIN, STEVEN GRAY (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GRAY
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E MOREHEAD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2700
Mailing Address - Country:US
Mailing Address - Phone:704-332-5069
Mailing Address - Fax:704-332-5090
Practice Address - Street 1:817 E MOREHEAD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2700
Practice Address - Country:US
Practice Address - Phone:704-332-5069
Practice Address - Fax:704-332-5090
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79-93383Medicaid