100 South Bloomfield Professional, LLC
Organization Active NPI General Practice Dentistry · Bloomfield, NM
NPI 1912519067 · NPPES record last updated Aug 20, 2020
Key facts
- NPI
- 1912519067
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- 100 SOUTH BLOOMFIELD PROFESSIONAL, LLC
- Practice address
- 100 S 1St St
Bloomfield, NM 87413-6242 - Phone
- (505) 632-3344
- NPI assigned
- Aug 20, 2020
- Organization subpart
- No
Authorized official
- Name
- Peter Grumbos, DDS
- Title
- Owner
- Phone
- (505) 632-3344
Practitioners 5
-
Jordan Chase Morris, DMD
-
Alex Wah Yuen, DDS
-
Oghenejiro Akpobome, DDS
-
Lauren Fangman Schau, DDS
National Provider Directory
Locations
100 S 1st St
Bloomfield, NM 87413
Phone (505) 632-3344
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
100 S 1St St
Bloomfield, NM 87413-6242
Mailing address
100 S 1St St
Bloomfield, NM 87413-6242
Phone (505) 632-3344
Other names
- Sundance Dental Care of Bloomfield
Other providers in Bloomfield, NM
- 803 Hacienda Lane Opco, LLC
- 803 Hacienda Lane Operations LLC
- Able Clinical Services Inc.
- Georgina G. Alby
- Angel Peak Counseling, LLC
All providers in Bloomfield, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.