Provider Demographics
NPI:1821151887
Name:GRIMM, TAMARA LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LEIGH
Last Name:GRIMM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317
Mailing Address - Country:US
Mailing Address - Phone:319-626-3971
Mailing Address - Fax:
Practice Address - Street 1:380 E HICKORY ST
Practice Address - Street 2:P.O. BOX M
Practice Address - City:RIVERSIDE
Practice Address - State:IA
Practice Address - Zip Code:52327-9665
Practice Address - Country:US
Practice Address - Phone:319-648-3900
Practice Address - Fax:319-648-3410
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice