Provider Demographics
NPI:1093828691
Name:GRIMALDI, LARRY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:GRIMALDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E FLORIDA AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544
Mailing Address - Country:US
Mailing Address - Phone:951-658-7251
Mailing Address - Fax:951-658-7251
Practice Address - Street 1:1600 E FLORIDA AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544
Practice Address - Country:US
Practice Address - Phone:951-658-7251
Practice Address - Fax:951-658-7251
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA025395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist