# 920 LOBO CANYON GRANTS PROFESSIONAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sundance Dental Care of Grants
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477218964
- **Authorized official:** PETER GRUMBOS DDS (DENTIST/OWNER)
- **Authorized official phone:** (505) 722-4422

## Contact information

- **Practice address:** 920 LOBO CANYON RD, GRANTS, NM 87020-2173
- **Practice address phone:** (505) 722-4422
- **Mailing address:** 920 LOBO CANYON RD, GRANTS, NM 87020-2173
- **Mailing address phone:** (505) 722-4422

## Taxonomy

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

## Other

- **Enumeration date:** 11/01/2021
- **Last updated:** 11/01/2021