NPIMap

Organization Active NPI

920 North Main Street Professional, PLLC

  • General Practice Dentistry
  • Taylor, TX
National Provider Identifier
1346867926
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
920 NORTH MAIN STREET PROFESSIONAL, PLLC
Practice address
920 N Main St
Taylor, TX 76574-3230
Phone
(512) 352-5577
Fax
(512) 352-7416
NPI assigned
Jun 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Authorized official

Name
Peter Grumbos, DMD
Title
Owner Dentist
Phone
(512) 352-5577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

920 N Main St
Taylor, TX 76574-3230

Mailing address

920 N Main St
Taylor, TX 76574-3230
Phone (512) 352-5577

Other names 1

  • Taylor Dental Associates & EZ Braces Doing business as

National Provider Directory

National Provider Directory

Locations

920 N Main St
Taylor, TX 76574
Phone (512) 352-5577

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593475200000",
    "number": "1346867926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 N MAIN ST",
            "city": "TAYLOR",
            "state": "TX",
            "postal_code": "765743230",
            "telephone_number": "512-352-5577",
            "fax_number": "512-352-7416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 N MAIN ST",
            "city": "TAYLOR",
            "state": "TX",
            "postal_code": "765743230",
            "telephone_number": "512-352-5577",
            "fax_number": "512-352-7416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "920 NORTH MAIN STREET PROFESSIONAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-30",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A",
        "authorized_official_last_name": "GRUMBOS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "512-352-5577",
        "authorized_official_credential": "DMD"
    },
    "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": "Taylor Dental Associates & EZ Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taylor, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.