Provider Demographics
NPI:1598884991
Name:GRIMMER, LONNY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LONNY
Middle Name:DEAN
Last Name:GRIMMER
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 1:44345 PREMIER PLZ
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5053
Mailing Address - Country:US
Mailing Address - Phone:703-723-1400
Mailing Address - Fax:703-723-2772
Practice Address - Street 1:44345 PREMIER PLZ
Practice Address - Street 2:SUITE 230
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5053
Practice Address - Country:US
Practice Address - Phone:703-723-1400
Practice Address - Fax:703-723-2772
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice