Individual
DR. BRENTLY ALLAN GRIMARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
3903 OUTLOOK BLVD, PUEBLO, CO 81008-1624
(719) 545-6485
(719) 545-6486
Mailing address
3903 OUTLOOK BLVD, PUEBLO, CO 81008-1624
(719) 545-6485
(719) 545-6486
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
8681
CO
Other
Enumeration date
12/24/2007
Last updated
12/02/2008
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