Peter Grumbos DDS Shallotte PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PETER GRUMBOS DDS SHALLOTTE PLLC

Practice address

343 Whiteville Rd NW
Shallotte, NC 28470-4507

Phone

(910) 754-4507

NPI assigned

Feb 14, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Brooks

Title

Credentialing Manager

Phone

(252) 292-1349

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1336846906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 WHITEVILLE RD NW",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284704507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 WHITEVILLE RD NW",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284704507",
            "telephone_number": "910-754-4507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER GRUMBOS DDS SHALLOTTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "252-292-1349"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Shallotte, NC
• Providers in Shallotte, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.