Roger Glen Grimball Jr. D.D.S. LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

ROGER GLEN GRIMBALL JR. D.D.S. LLC

Doing business as

Grimball Pediatric Dentistry

Practice address

1570 Maplewood Dr
Sulphur, LA 70663-5643

Phone

(337) 625-2212

Fax

(337) 625-3231

NPI assigned

May 19, 2021

Last updated

Jul 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Roger Glen Grimball Jr.NPI 1003830597

Title

Dentist

Phone

(337) 625-2212

Specialties & licenses 1

Addresses

Other names 1

• Grimball Pediatric Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roger Glen Grimball Jr., D.D.S.

  • Pediatric Dentistry
  • Sulphur, LA
  • NPI 1003830597
  NPD Authorized official
• Virginia Nocilla Grimball, DDS

  • General Practice Dentistry
  • Sulphur, LA
  • NPI 1740874825
  NPD

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1821662297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 MAPLEWOOD DR",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706635643",
            "telephone_number": "337-625-2212",
            "fax_number": "331-625-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 MAPLEWOOD DR",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706635643",
            "telephone_number": "337-625-2212",
            "fax_number": "337-625-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER GLEN GRIMBALL JR. D.D.S. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "GRIMBALL",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "337-625-2212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grimball Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 28, 2021; 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.