Healthcare Provider Details

I. General information

NPI: 1780726810
Provider Name (Legal Business Name): STEPHEN EDWARD GRIMM III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOWARD UNIVERSITY COLLEGE OF DENTISTRY 600 W STREET, NW
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

HOWARD UNIVERSITY COLLEGE OF DENTISTRY 600 W STREET, NW
WASHINGTON DC
20059-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-0308
  • Fax: 202-806-0354
Mailing address:
  • Phone: 202-806-0308
  • Fax: 202-806-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN3922
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7842
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401006276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: