| 1724 State Summerville Professional, Llc | |
|
1724 State Rd Unit 4d Summerville SC 29486-2842 | |
| (843) 352-4454 | |
| (843) 352-4875 |
| Full Name | 1724 State Summerville Professional, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1724 State Rd Unit 4d, Summerville, South Carolina |
| Authorized Official Name and Position | Peter Grumbos (OWNER) |
| Authorized Official Contact | 8433524454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1724 State Summerville Professional, Llc 1724 State Rd Unit 4d Summerville SC 29486-2842 Ph: (843) 352-4454 | 1724 State Summerville Professional, Llc 1724 State Rd Unit 4d Summerville SC 29486-2842 Ph: (843) 352-4454 |
| NPI Number | 1730847724 |
|---|---|
| Provider Enumeration Date | 12/07/2021 |
| Last Update Date | 12/07/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730847724 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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