Individual
DR. ROGER GLEN GRIMBALL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
910 BEGLIS PKWY, SULPHUR, LA 70663-5102
(337) 625-2212
(337) 625-3231
Mailing address
910 BEGLIS PKWY, SULPHUR, LA 70663-5102
(337) 625-2212
(337) 625-3231
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5330
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1853305
—
LA
Enumeration date
07/27/2006
Last updated
07/08/2007
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