Organization
FRED GRIMES,D.D.S., INC
Active
Other names
Creek Street Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN FRED GRIMES D.D.S. (OWNER)
(830) 990-1178
Entity
Organization
Contact information
Practice address
101 W CREEK ST, FREDERICKSBURG, TX 78624-3730
(830) 990-1178
(830) 990-2338
Mailing address
101 W CREEK ST, FREDERICKSBURG, TX 78624-3730
(830) 990-1178
(830) 990-2338
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8430
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009594501
—
TX
Enumeration date
01/17/2012
Last updated
01/17/2012
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