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General NPI Number Information
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NPI Number | 1285783563
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Entity Type | Individual
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Provider Name | MARY HEIL GRIMM DMD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9785 MACKENZIE SUITE 106
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City | ST LOUIS
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State | MO
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Zip | 63123
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Country | US
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Telephone | 314-631-2000
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Fax | 314-631-2002
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Provider Business Mailing Address
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Address Line | 1290 TAMMANY LANE
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City | ST LOUIS
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State | MO
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Zip | 63131
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Country | US
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Telephone | 314-275-7789
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Fax | 314-579-0788
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 014062
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License Number State | MO
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