Doctor Name: | DR. ROGER GLEN GRIMBALL |
NPI Number: | 1003830597 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.D.S. |
License Number: | 5330 |
Business Practice Address: | 910 Beglis Pkwy Sulphur, LA - 706635102 |
Business Phone Number: | 3376252212 |
Business Fax Number: | 3376253231 |
Mailing Address: | 910 Beglis Pkwy, SULPHUR |
State: | LA |
Postal Code: | 706635102 |
Phone Number: | 3376252212 |
Fax Number: | 3376253231 |
NPI Enumeration Date: | 07/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 5330 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |