Provider Demographics
NPI:1811071384
Name:GRIMM, KEVIN SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
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 1:8609 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4398
Mailing Address - Country:US
Mailing Address - Phone:810-225-0022
Mailing Address - Fax:810-225-0033
Practice Address - Street 1:8609 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4398
Practice Address - Country:US
Practice Address - Phone:810-225-0022
Practice Address - Fax:810-225-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist