Provider Demographics
NPI:1134836364
Name:MDG - GRIFFIN DENTAL LLC
Entity type:Organization
Organization Name:MDG - GRIFFIN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-592-4360
Mailing Address - Street 1:102 CRESCENT W STE B
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4862
Mailing Address - Country:US
Mailing Address - Phone:770-412-8636
Mailing Address - Fax:770-412-7019
Practice Address - Street 1:102 CRESCENT W STE B
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4862
Practice Address - Country:US
Practice Address - Phone:770-412-8636
Practice Address - Fax:770-412-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental