Provider Demographics
NPI:1356723985
Name:GRIMM, HILARY SARTAIN (DMD)
Entity type:Individual
Prefix:DR
First Name:HILARY
Middle Name:SARTAIN
Last Name:GRIMM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-2009
Mailing Address - Country:US
Mailing Address - Phone:228-990-2769
Mailing Address - Fax:
Practice Address - Street 1:410 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040
Practice Address - Country:US
Practice Address - Phone:847-230-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21248122300000X
IL019.0319121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist