Individual
MR. DWIGHT GRIMM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
912 WAYNOKA DR, LAKE WAYNOKA, OH 45171-9760
(937) 446-4149
Mailing address
912 WAYNOKA DR, LAKE WAYNOKA, OH 45171-9760
(937) 446-4149
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800557
—
OH
05
—
2971048
—
OH
Enumeration date
09/30/2020
Last updated
09/30/2020
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