Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 12166 | MA |
NPI | 1114188448 |
---|---|
Provider Name | Dr. Terrence J Griffin |
First Address | Boston, MA 02116-2636 |
Second Address | Boston, MA 02116-2636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 19/06/2008 |