Provider Demographics
NPI:1619498219
Name:GRIMMER, MITCHELL DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
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 1:7205 HANCOCK VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2782
Mailing Address - Country:US
Mailing Address - Phone:804-332-6310
Mailing Address - Fax:
Practice Address - Street 1:7205 HANCOCK VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2782
Practice Address - Country:US
Practice Address - Phone:804-332-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist