Provider Demographics
NPI:1730969254
Name:GRIFFIN, DOMINICA RENEE
Entity type:Individual
Prefix:MS
First Name:DOMINICA
Middle Name:RENEE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOMINICA
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BE YOUR BETTER YOU
Mailing Address - Street 1:1125 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1308
Mailing Address - Country:US
Mailing Address - Phone:216-260-5514
Mailing Address - Fax:
Practice Address - Street 1:1125 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1308
Practice Address - Country:US
Practice Address - Phone:216-260-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty