| 627 Main Tupelo Professional Pllc | |
|
627 W Main St Tupelo MS 38804-3732 | |
| (662) 840-0066 | |
| (662) 840-7966 |
| Full Name | 627 Main Tupelo Professional Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 627 W Main St, Tupelo, Mississippi |
| Authorized Official Name and Position | Peter Grumbos (OWNER) |
| Authorized Official Contact | 6628400066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 627 Main Tupelo Professional Pllc 627 W Main St Tupelo MS 38804-3732 Ph: (662) 840-0066 | 627 Main Tupelo Professional Pllc 627 W Main St Tupelo MS 38804-3732 Ph: (662) 840-0066 |
| NPI Number | 1255045019 |
|---|---|
| Provider Enumeration Date | 01/06/2023 |
| Last Update Date | 01/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255045019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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