Roger Glen Grimball Jr., D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

5330 Issued in LA

Practice address

910 Beglis Pkwy
Sulphur, LA 70663-5102

Phone

(337) 625-2212

Fax

(337) 625-3231

NPI assigned

Jul 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Roger Glen Grimball Jr. D.D.S. LLC

  dba Grimball Pediatric Dentistry

  • Pediatric Dentistry
  • Sulphur, LA
  • NPI 1821662297
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003830597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 BEGLIS PKWY",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706635102",
            "telephone_number": "337-625-2212",
            "fax_number": "337-625-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 BEGLIS PKWY",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706635102",
            "telephone_number": "337-625-2212",
            "fax_number": "337-625-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMBALL",
        "first_name": "ROGER",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "5330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1853305",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Gormly, CRNA
• Krysta Gould
• Jadah Granger, APRN
• Grimball & Richert Clinic
• Roger G Grimball, MD
• Virginia Nocilla Grimball, DDS
• Brett Gschwend, D.C.
• Jackie Lynn Guidry, NP
• Kevin Michale Guilbeaux, PT
• Steven Paul Guillory, RPH

• Pediatric Dentistry in Sulphur, LA
• Providers in Sulphur, LA by specialty
• Pediatric Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.