Healthcare Provider Details

I. General information

NPI: 1700525284
Provider Name (Legal Business Name): DALEY LYNN HARVEY GRINNIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N JAMES ST
JACKSONVILLE AR
72076-4018
US

IV. Provider business mailing address

24 SPRING ST
CABOT AR
72023-2473
US

V. Phone/Fax

Practice location:
  • Phone: 501-436-0355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4595
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: