# PETER GRUMBOS DDS RANDOLPH PLLC

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

## Provider details

- **NPI number:** 1598475949
- **Authorized official:** MRS. AMY BROOKS (CREDENTIALING MANAGER)
- **Authorized official phone:** (252) 292-1349

## Contact information

- **Practice address:** 2711 RANDOLPH RD STE 205, CHARLOTTE, NC 28207-2027
- **Practice address phone:** (704) 377-2503
- **Practice address fax:** (704) 377-6032
- **Mailing address:** 12200 W FINCH AVE, MIDDLESEX, NC 27557-7427
- **Mailing address phone:** (252) 292-1349
- **Mailing address fax:** (919) 278-2657

## Taxonomy

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

## Other

- **Enumeration date:** 11/28/2022
- **Last updated:** 11/28/2022