| NPI | 1194181560 |
|---|---|
| Former Legal Business Name | TARA M GRIFFIN DMD LLC |
| Entity Type | Organization |
| Authorized Contact | ERICA MICHELLE HARRIS Practice Manager 309-319-6568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019021753) |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2016-01-14 |