Individual
DR. LISA RENEE GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1204 W WILLOW RD, STE. C, ENID, OK 73703-2531
(580) 233-1427
(580) 233-1423
Mailing address
2020 INDIAN DR, ENID, OK 73703-6711
(580) 242-3736
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5575
OK
1223G0001X
General Practice Dentistry
Primary
10214
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100043850A
—
OK
Enumeration date
01/17/2007
Last updated
01/11/2019
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