Provider Demographics
NPI:1770563959
Name:GRIMSHAW, BETTY J (RDH)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:J
Last Name:GRIMSHAW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 PONTE VEDRA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5800
Mailing Address - Country:US
Mailing Address - Phone:904-273-0324
Mailing Address - Fax:904-273-0324
Practice Address - Street 1:220 3RD AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6727
Practice Address - Country:US
Practice Address - Phone:904-249-9069
Practice Address - Fax:904-249-8862
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 7248124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist