Provider Demographics
NPI:1366720401
Name:GRIMES, DALE O
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:O
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OFFENHAUSER
Mailing Address - Street 2:#517
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-258-9335
Mailing Address - Fax:775-322-4460
Practice Address - Street 1:900 W 1ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5675
Practice Address - Country:US
Practice Address - Phone:775-677-2216
Practice Address - Fax:775-322-4460
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor