Individual provider Active NPI

Griffin Lavelle Deen Jr., DDS

  • General Practice Dentistry
  • Covington, LA
National Provider Identifier
1003811753
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4346 Issued in LA
Practice address
122 E 21St Ave
Covington, LA 70433-2814
Phone
(985) 867-9122
Fax
(985) 867-9169
NPI assigned
Jun 18, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4346 LA Primary

Addresses

Primary practice location

122 E 21St Ave
Covington, LA 70433-2814

Mailing address

122 E 21St Ave
Covington, LA 70433-2814
Phone (985) 867-9122

Other identifiers 3

IdentifierTypeStateIssuer
1843466MedicaidLA
V04346OtherTXBLUE CROSS/BLUE SHIELD
A2119OtherLABLUE CROSS/BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160316000287 LA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 8224334388

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4346LAMDGeneral Practice Dentistry

Networks

  • MS PPO C-SNP
  • TX HMO D-SNP
  • LA PPO C-SNP
  • MS PPO D-SNP

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1003811753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E 21ST AVE",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704332814",
            "telephone_number": "985-867-9122",
            "fax_number": "985-867-9169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E 21ST AVE",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704332814",
            "telephone_number": "985-867-9122",
            "fax_number": "985-867-9169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEEN",
        "first_name": "GRIFFIN",
        "middle_name": "LAVELLE",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "4346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1843466",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "V04346",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "A2119",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.