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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