Provider Demographics
NPI:1821184086
Name:GRIMES, PERRY THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:THOMAS
Last Name:GRIMES
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 1:601 TAMA ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-4804
Mailing Address - Country:US
Mailing Address - Phone:319-366-2451
Mailing Address - Fax:319-366-1602
Practice Address - Street 1:601 TAMA ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-4804
Practice Address - Country:US
Practice Address - Phone:319-366-2451
Practice Address - Fax:319-366-1602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA64801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice