Active NPI
Susan Ann Grimes, DDS
- General Practice Dentistry
- Shelburne, VT
National Provider Identifier
1710913157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- VT 966
- Practice address
- 30 Shelburne Shopping Park
Shelburne, VT 05482-7488 - Phone
- (802) 983-3500
- NPI assigned
- Jun 25, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | VT 966 | VT | Primary |
Addresses
Primary practice location
30 Shelburne Shopping Park
Shelburne, VT 05482-7488
Mailing address
30 Shelburne Shopping Park
Shelburne, VT 05482-7488
Phone (802) 985-3500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002660 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VT 966 | VT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710913157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 SHELBURNE SHOPPING PARK",
"city": "SHELBURNE",
"state": "VT",
"postal_code": "054827488",
"telephone_number": "802-985-3500",
"fax_number": "802-985-2979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 SHELBURNE SHOPPING PARK",
"city": "SHELBURNE",
"state": "VT",
"postal_code": "054827488",
"telephone_number": "802-983-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMES",
"first_name": "SUSAN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VT",
"license": "VT 966",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1002660",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelburne, VT
- Timothy C Gould, DPT
- Green Mountain Anesthesia, LLC
- Green Mountain Eldercare
- Green Mountain Eldercare, LLC
- Joan N Leyrer Greene, APRN CPNP
- Maria Garrity Grindle, M.S.
- John F. Guerriere, D.C.
- Gregory P. Guilmartin, LICENSED OPTICIAN
- Carl J Gutierrez, M.D.
- Health in Focus: the Center for Chiropractic & Applied Kinesiology PLC
Sources for this page
- 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.