Provider Demographics
NPI:1912053000
Name:GRIMES, WILLIAM LLOYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LLOYD
Last Name:GRIMES
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 1:100 SIMPSON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3932
Mailing Address - Country:US
Mailing Address - Phone:304-522-3135
Mailing Address - Fax:
Practice Address - Street 1:1125 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2021
Practice Address - Country:US
Practice Address - Phone:304-529-2739
Practice Address - Fax:304-529-0068
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice