1601 2nd Street Gallup Professional, LLC
NPI #1386309870 in Gallup, New Mexico
Provider Information
- NPI Number
- 1386309870
- Entity Type
- Organization
- Organization Name
- 1601 2nd Street Gallup Professional, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Nov 1, 2021
- Last Updated
- Nov 1, 2021
Practice Location
- Address
- 1601 S SECOND ST
- City
- Gallup
- State
- New Mexico
- ZIP Code
- 87301-5816
- Phone
- (505) 722-4422
Authorized Official
- Name
- DR. PETER GRMBOS, DDS
- Title
- OWNER/DENTIST
- Phone
- (505) 722-4422
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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