Healthcare Provider Details

I. General information

NPI: 1831754100
Provider Name (Legal Business Name): NA EUN CHUNG GRIMES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1379 TUCKER RD
NORTH DARTMOUTH MA
02747-3152
US

IV. Provider business mailing address

1379 TUCKER RD
NORTH DARTMOUTH MA
02747-3152
US

V. Phone/Fax

Practice location:
  • Phone: 508-993-9105
  • Fax:
Mailing address:
  • Phone: 714-308-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN1860048
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: