| NPI | 1255045019 |
|---|---|
| Doing Business As | MAIN STREET FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | PETER GRUMBOS Owner 662-840-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2023-01-06 |