Dr. Russell T Grimm, D.D.S.
Dentist in Madison, WI. Individual provider (NPI-1).
NPI number1508085481
StatusActive
Last updated in NPPESOct 8, 2013
Details
- NPI
- 1508085481
- Entity type
- Individual (NPI-1)
- Name
- Dr. Russell T Grimm
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 25, 2007
- Last updated
- Oct 8, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 5193-015 | WI | Yes |
| 1223G0001X | Dentist, General Practice | 5193 | WI |
Practice location
749 University RowMadison, WI 53705
Phone 608-238-7112 · Fax 608-238-1061
Mailing address
749 University RowMadison, WI 53705
Phone 608-238-7112 · Fax 608-238-1061
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