Provider Demographics
NPI:1811925647
Name:GRIMM, JESSE ARON (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ARON
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 1:851 OLD WINSTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8780
Mailing Address - Country:US
Mailing Address - Phone:336-996-7770
Mailing Address - Fax:336-996-7782
Practice Address - Street 1:851 OLD WINSTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8780
Practice Address - Country:US
Practice Address - Phone:336-996-7770
Practice Address - Fax:336-996-7782
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6226OtherLICENSES NUMBER
NC8993337Medicaid
NC8993337Medicaid
NC8993337Medicaid