Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2748 | OK |
N | 1223E0200X | Endodontist | 3 | OK |
NPI | 1093725913 |
---|---|
Provider Name | Dr. Edward William Grimes |
First Address | Tulsa, OK 74137 |
Second Address | Tulsa, OK 74137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |