Individual
MARK A GRIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4437 BROOKFIELD CORPORATE DR, #107, CHANTILLY, VA 20151-2122
(703) 222-5400
(703) 222-0740
Mailing address
4437 BROOKFIELD CORPORATE DRIVE, #107, CHANTILLY, VA 20151
(703) 222-5400
(703) 222-0740
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401006539
VA
Other
Enumeration date
06/14/2013
Last updated
06/14/2013
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