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General NPI Number Information
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NPI Number | 1316750425
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Entity Type | Organization
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Legal Business Name | GRIMES DENTAL ENTERPRISES, LLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 100 SW BROOKSIDE DR
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City | GRIMES
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State | IA
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Zip | 50111-4953
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Country | US
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Telephone | 515-986-3926
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 AURORA AVE
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City | SPIRIT LAKE
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State | IA
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Zip | 51360-7097
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Country | US
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Telephone | 712-336-3037
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAUN O'NEILL
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Credential |
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Telephone | 608-289-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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