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General NPI Number Information
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NPI Number | 1164412516
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Entity Type | Individual
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Provider Name | DENNIS JOSEPH GRILL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3851 ROGER BROOKE DR BROOKE ARMY MEDICAL CENTER (MCHE-QD/CREDENTIALS)
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4501
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Country | US
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Telephone | 210-916-2460
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Fax |
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Provider Business Mailing Address
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Address Line | 5991 TEMERITY WAY
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City | BULVERDE
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State | TX
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Zip | 78163-4170
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Country | US
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Telephone | 830-980-6192
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Fax | 830-980-6193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22863
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License Number State | TX
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