100 South Bloomfield Professional, LLC
NPI 1912519067ActiveOrganization· Dentist, General Practice· Bloomfield, NM
Dentist, General Practice in Bloomfield, New Mexico, registered in NPPES in August 2020. The authorized official on file is Peter Grumbos, DDS, Owner.
Overview
| NPI | 1912519067 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 20, 2020 |
| Last updated in NPPES | Aug 20, 2020 |
| Certified by provider | Aug 20, 2020 |
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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