Provider Demographics
NPI:1558371013
Name:GRIMES, JAMES T JR (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:GRIMES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311185
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1185
Mailing Address - Country:US
Mailing Address - Phone:334-347-3061
Mailing Address - Fax:334-347-1101
Practice Address - Street 1:551 GLOVER AVE
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2041
Practice Address - Country:US
Practice Address - Phone:334-347-3061
Practice Address - Fax:334-347-1101
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
86043OtherUNITED CONCORDIA
AL92840OtherBCBS