Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 15322 | TX |
NPI | 1225119365 |
---|---|
Provider Name | Dr. Donn Alan Grimes |
First Address | Heber City, UT 84032-4326 |
Second Address | Heber City, UT 84032-4326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 03/04/2017 |