1661 W 2nd Corsicana Professional, Pllc

NPI #1225673098 in Corsicana, Texas

Provider Information

NPI Number: 1225673098
Entity Type: Organization
Organization Name: 1661 W 2nd Corsicana Professional, Pllc
Primary Specialty: Dentist
Enumeration Date: Nov 15, 2019
Last Updated: Apr 20, 2020

Practice Location

Address: 1661 W 2ND AVE
City: Corsicana
State: Texas
ZIP Code: 75110-4107
Phone: (903) 872-1661

Authorized Official

Name: PETER GRUMBOS, DMD
Title: OWNER
Phone: (214) 259-7000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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