Basic Information
| Provider Information | |||||||||
| NPI: | 1407455736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | ASHLEE | ||||||||
| MiddleName: | KRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 E STEWART AVE BLDG 2019 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809142900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1055 E STEWART AVE BLDG 2019 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809142900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2020 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 126800000X | Y | Dental Providers | Dental Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1516901035 | 01 | TRICARE | OTHER |