Healthcare Provider Details

I. General information

NPI: 1730334251
Provider Name (Legal Business Name): FRANK MARLIN GRIMES DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 W MAIN ST
HENDERSONVILLE TN
37075-3304
US

IV. Provider business mailing address

110 N OAK ST
SPRINGFIELD TN
37172-2004
US

V. Phone/Fax

Practice location:
  • Phone: 615-824-4833
  • Fax: 615-824-4781
Mailing address:
  • Phone: 615-477-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1993
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: