627 Main Tupelo Professional PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

627 MAIN TUPELO PROFESSIONAL PLLC

Practice address

627 W Main St
Tupelo, MS 38804-3732

Phone

(662) 840-0066

Fax

(662) 840-7966

NPI assigned

Jan 6, 2023

Organization subpart

No

Name

Peter Grumbos, DDS

Title

Owner

Phone

(662) 840-0066

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brett M Hildenbrand, D.M.D.

  • General Practice Dentistry
  • Tupelo, MS
  • NPI 1811105729

  General Practice

  NPD (past)
• Harry J Rayburn, D.M.D

  • General Practice Dentistry
  • Tupelo, MS
  • NPI 1407064306

  General Practice

  NPD (past)

• Main Street Family Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 6, 2023.

{
    "created_epoch": "1672963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672963200000",
    "number": "1255045019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 W MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388043732",
            "telephone_number": "662-840-0066",
            "fax_number": "662-840-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 W MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388043732",
            "telephone_number": "662-840-0066",
            "fax_number": "662-840-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "627 MAIN TUPELO PROFESSIONAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-06",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "GRUMBOS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-840-0066",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Charles Abavaredo, DO
• Haritha Abbott, CRNA
• Elsheikh Mamoun Elsheikh Abdelrahim

• All providers in Tupelo, MS
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.