# 1661 W 2ND CORSICANA SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083234744
- **Authorized official:** PETER GRUMBOS DDS (OWNER)
- **Authorized official phone:** (903) 872-1661

## Contact information

- **Practice address:** 1661 W 2ND AVE, CORSICANA, TX 75110-4107
- **Practice address phone:** (903) 872-1661
- **Mailing address:** 1661 W 2ND AVE, CORSICANA, TX 75110-4107
- **Mailing address phone:** (903) 872-1661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/23/2020
- **Last updated:** 04/23/2020