Individual
DR. RUSSELL T GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
749 UNIVERSITY ROW, MADISON, WI 53705
(608) 238-7112
(608) 238-1061
Mailing address
749 UNIVERSITY ROW, MADISON, WI 53705
(608) 238-7112
(608) 238-1061
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5193-015
WI
1223G0001X
General Practice Dentistry
5193
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33759600
—
WI
Enumeration date
04/25/2007
Last updated
10/08/2013
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