Peter Grumbos DDS Randolph PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PETER GRUMBOS DDS RANDOLPH PLLC

Practice address

2711 Randolph Rd Ste 205
Charlotte, NC 28207-2027

Phone

(704) 377-2503

Fax

(704) 377-6032

NPI assigned

Nov 28, 2022

Last updated

Nov 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Amy Brooks

Title

Credentialing Manager

Phone

(252) 292-1349

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Louis Berman

  • Dentist
  • Charlotte, NC
  • NPI 1902424021
  NPD
• Scott Menaker, DDS

  • Dentist
  • Charlotte, NC
  • NPI 1972531648
  NPD (past)
• Patricia Caroline Rodney, DDS

  • General Practice Dentistry
  • Charlotte, NC
  • NPI 1811070527
  NPD (past)

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1598475949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 W FINCH AVE",
            "city": "MIDDLESEX",
            "state": "NC",
            "postal_code": "275577427",
            "telephone_number": "252-292-1349",
            "fax_number": "919-278-2657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 RANDOLPH RD STE 205",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282072027",
            "telephone_number": "704-377-2503",
            "fax_number": "704-377-6032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER GRUMBOS DDS RANDOLPH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-28",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd Andrew Personett, DC
• Elena Pertgen
• Sunia Ayeza Pervez, MD
• Autivia Shanise Pervis
• Joshua Peshel
• Peter O Adamson Dba DDD Enterprise, LLC (DDD Enterprise, LLC)
• Joan Peter
• Erika Michelle Peterfy, PHARMD
• Angela Brown Peterkin, NP
• Amy H. Peterman, PHD

• General Practice Dentistry in Charlotte, NC
• Providers in Charlotte, 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 Nov 28, 2022; 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.