100 South Bloomfield Professional, LLC
NPI #1912519067 in Bloomfield, New Mexico
Provider Information
- NPI Number
- 1912519067
- Entity Type
- Organization
- Organization Name
- 100 South Bloomfield Professional, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Aug 20, 2020
- Last Updated
- Aug 20, 2020
Practice Location
- Address
- 100 S 1ST ST
- City
- Bloomfield
- State
- New Mexico
- ZIP Code
- 87413-6242
- Phone
- (505) 632-3344
Authorized Official
- Name
- PETER GRUMBOS, DDS
- Title
- OWNER
- Phone
- (505) 632-3344
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