627 Main Tupelo Professional PLLC
NPI 1255045019ActiveOrganization· Dentist, General Practice· Tupelo, MS
Dentist, General Practice in Tupelo, Mississippi, registered in NPPES in January 2023. The authorized official on file is Peter Grumbos, DDS, Owner.
Overview
| NPI | 1255045019 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 6, 2023 |
| Last updated in NPPES | Jan 6, 2023 |
| Certified by provider | Jan 6, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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