NPI 1083234744 · live from the CMS NPI Registry
1661 W 2nd Corsicana Services, LLC
Dentist, General Practice in Corsicana, TX. National Provider Identifier 1083234744, active.
NPI record
| NPI | 1083234744 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 1661 W 2nd Ave, Corsicana, TX 75110 |
| Practice phone | 903-872-1661 |
| Enumerated | April 23, 2020 |
| Last updated | April 23, 2020 |
| Authorized official | Peter Grumbos, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.