| NPI | 1285252627 |
|---|---|
| Doing Business As | FOUR CORNERS FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | PETER GRUMBOS Practice Owner 505-564-4470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |