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General NPI Number Information
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NPI Number | 1588186662
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Entity Type | Individual
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Provider Name | ELLEN B GRIMES RDH, ED.D
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Gender | Female
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 301 LAWRENCE PLACE VERMONT TECHNICAL COLLEGE
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City | WILLISTON
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State | VT
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Zip | 05495
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Country | US
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Telephone | 802-879-5643
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Fax |
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Provider Business Mailing Address
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Address Line | 49 LILAC LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-9200
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 015.0000919
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License Number State | VT
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