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Organization
1724 STATE SUMMERVILLE PROFESSIONAL, LLC
Active
Organization
1724 STATE SUMMERVILLE PROFESSIONAL, LLC
Active
Other names
Cane Bay Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
PETER GRUMBOS DDS (OWNER)
(843) 352-4454
Entity
Organization
Contact information
Practice address
1724 STATE RD UNIT 4D, SUMMERVILLE, SC 29486-2842
(843) 352-4454
(843) 352-4875
Mailing address
1724 STATE RD UNIT 4D, SUMMERVILLE, SC 29486-2842
(843) 352-4454
(843) 352-4875
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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