NPI 1225673098 · live from the CMS NPI Registry
1661 W 2nd Corsicana Professional, PLLC
Dentist in Corsicana, TX. National Provider Identifier 1225673098, active.
NPI record
| NPI | 1225673098 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 1661 W 2nd Ave, Corsicana, TX 75110 |
| Practice phone | 903-872-1661 |
| Enumerated | November 15, 2019 |
| Last updated | April 20, 2020 |
| Authorized official | Peter Grumbos, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.