Most Relevant Information
Provider Data
| NPI Number: | 1003830597 |
| Provider Name: | ROGER GLEN GRIMBALL D.D.S. |
| Entity Type: | Individual |
| Taxonomy Code: | 1223P0221X |
| Specialty: | Dentist |
| License Number: | 5330 |
Most Important Dates
| Enumeration Date: | 07/27/2006 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
910 BEGLIS PKWY
SULPHUR
LA
706635102
Practice Location Phone/Fax
| Phone: | 3376252212 |
| Fax: | 3376253231 |
Provider Mailing Location
910 BEGLIS PKWY
SULPHUR
LA
706635102
Provider Mailing Phone/Fax
| Phone: | 3376252212 |
| Fax: | 3376253231 |