Provider Demographics
NPI:1447340815
Name:THOMAS GRIMES, DDS
Entity type:Organization
Organization Name:THOMAS GRIMES, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-366-2451
Mailing Address - Street 1:601 TAMA ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AL
Mailing Address - Zip Code:52302-4804
Mailing Address - Country:US
Mailing Address - Phone:319-366-2451
Mailing Address - Fax:
Practice Address - Street 1:601 TAMA ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-4804
Practice Address - Country:US
Practice Address - Phone:319-366-2451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA64801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty