| 1601 2nd Street Gallup Professional, Llc | |
|
1601 S Second St Gallup NM 87301-5816 | |
| (505) 722-4422 | |
| (505) 722-2060 |
| Full Name | 1601 2nd Street Gallup Professional, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1601 S Second St, Gallup, New Mexico |
| Authorized Official Name and Position | Peter Grmbos (OWNER/DENTIST) |
| Authorized Official Contact | 5057224422 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1601 2nd Street Gallup Professional, Llc 1601 S Second St Gallup NM 87301-5816 Ph: (505) 722-4422 | 1601 2nd Street Gallup Professional, Llc 1601 S Second St Gallup NM 87301-5816 Ph: (505) 722-4422 |
| NPI Number | 1386309870 |
|---|---|
| Provider Enumeration Date | 11/01/2021 |
| Last Update Date | 11/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386309870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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