Provider Demographics
NPI:1891991451
Name:GRIMM, DAVID C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:GRIMM
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 1:10827 HARTLE DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-9762
Mailing Address - Country:US
Mailing Address - Phone:301-824-6319
Mailing Address - Fax:301-824-6318
Practice Address - Street 1:17719 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7085
Practice Address - Country:US
Practice Address - Phone:301-714-2244
Practice Address - Fax:301-714-0153
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice