Organization
3501 NORTH BUTLER AVENUE FARMINGTON PROFESSIONAL LLC
Active
Other names
Four Corners Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
PETER GRUMBOS DDS (PRACTICE OWNER)
(505) 564-4470
Entity
Organization
Contact information
Practice address
3501 N BUTLER AVE STE 104, FARMINGTON, NM 87401-6430
(505) 564-4470
(505) 325-9707
Mailing address
3501 N BUTLER AVE STE 104, FARMINGTON, NM 87401-6430
(505) 564-4470
(505) 325-9707
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/13/2020
Last updated
07/13/2020
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