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General NPI Number Information
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NPI Number | 1356723985
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Entity Type | Individual
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Provider Name | HILARY SARTAIN GRIMM D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 410 GREEN BAY RD
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City | HIGHWOOD
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State | IL
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Zip | 60040
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Country | US
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Telephone | 847-230-9394
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Fax |
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Provider Business Mailing Address
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Address Line | 83 WESTOVER RD
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City | HIGHWOOD
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State | IL
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Zip | 60040-2009
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Country | US
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Telephone | 228-990-2769
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Fax |
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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 | DN21248
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.031912
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License Number State | IL
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