NPIMap

Organization Active NPI

Fred Grimes,D.D.S., Inc

  • Dentist
  • Fredericksburg, TX
National Provider Identifier
1487925848
Registry record updated Jan 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8430 Issued in TX
Legal business name
FRED GRIMES,D.D.S., INC
Practice address
101 W Creek St
Fredericksburg, TX 78624-3730
Phone
(830) 990-1178
Fax
(830) 990-2338
NPI assigned
Jan 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2012

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

Authorized official

Name
Dr. Edwin Fred Grimes, D.D.S.NPI 1972726172
Title
Owner
Phone
(830) 990-1178

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 8430 TX Primary

Addresses

Primary practice location

101 W Creek St
Fredericksburg, TX 78624-3730

Mailing address

101 W Creek St
Fredericksburg, TX 78624-3730
Phone (830) 990-1178

Other identifiers 1

IdentifierTypeStateIssuer
009594501MedicaidTX

Other names 1

  • Creek Street Dental Doing business as

National Provider Directory

National Provider Directory

Locations

101 W Creek St
Fredericksburg, TX 78624
Phone (830) 990-1178

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1487925848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W CREEK ST",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786243730",
            "telephone_number": "830-990-1178",
            "fax_number": "830-990-2338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W CREEK ST",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786243730",
            "telephone_number": "830-990-1178",
            "fax_number": "830-990-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED GRIMES,D.D.S., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-17",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "FRED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-990-1178",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "8430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009594501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creek Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredericksburg, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2012; 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.