# PETER GRUMBOS DDS REIDSVILLE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568161263
- **Authorized official:** AMY BROOKS (CREDENTIALING MANAGER)
- **Authorized official phone:** (252) 292-1349

## Contact information

- **Practice address:** 1109 S PARK DR, REIDSVILLE, NC 27320-5513
- **Practice address phone:** (336) 342-0889
- **Practice address fax:** (336) 344-8669
- **Mailing address:** 1109 S PARK DR, REIDSVILLE, NC 27320-5513
- **Mailing address phone:** (336) 342-0889
- **Mailing address fax:** (336) 344-8669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |

## Other

- **Enumeration date:** 03/01/2023
- **Last updated:** 11/28/2023