What is 1661 W 2ND CORSICANA PROFESSIONAL, PLLC's NPI number?

The NPI number assigned to this healthcare provider is 1225673098, enumerated as a organization on November 15, 2019.

Where is the provider located?

The provider is located at 1661 W 2ND AVE CORSICANA, TX 75110 and the phone number is (903) 872-1661.

What is the provider's specialty?

The provider's specialty is Dentist with taxonomy code 122300000X.

1661 W 2ND CORSICANA PROFESSIONAL, PLLC - NPI 1225673098

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About 1661 W 2nd Corsicana Professional, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

1661 W 2ND CORSICANA PROFESSIONAL, PLLC (NPI 1225673098) is a healthcare organization registered as a dentist in Corsicana, Texas and active in the NPI registry since November 2019. The organization lists Peter Grumbos, Owner, as its authorized official.Information from the official NPPES registry record, last updated April 20, 2020.

NPPES Registry Identity

NPI1225673098

Entity TypeOrganization

Legal Business Name1661 W 2ND CORSICANA PROFESSIONAL, PLLC

Location Address1661 W 2ND AVECorsicana, TX 75110-4107

Mailing Address1661 W 2nd AveCorsicana, TX 75110-4107 · (903) 872-1661

Phone(903) 872-1661

Organization SubpartNo

Authorized OfficialPeter GrumbosOwner · (214) 259-7000

Enumeration DateNovember 15, 2019

Last NPPES UpdateApril 20, 20202 updates tracked since enumeration

NPPES CertifiedApril 20, 2020

✔ NPI 1225673098 is a valid, active identifier and passes the ISO check-digit test. How NPI validation works

★ Primary Specialty

Dentist

Taxonomy 122300000X · Dental Providers

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the… Show more

1661 W 2ND AVE, Corsicana, TX 75110

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Also on File with NPPES

Group Practice1

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization. (193200000X MULTI-SPECIALTY GROUP)