Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8652 | NC |
Y | 1223P0700X | Prosthodontist | 8652 | NC |
NPI | 1245452176 |
---|---|
Provider Name | Dr. Mollie Elizabeth Griswold |
First Address | Charlotte, NC 28226 |
Second Address | Charlotte, NC 28226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 01/03/2017 |