Provider Demographics
NPI:1184825820
Name:GREWAL, MANREET (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANREET
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ADAMS AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4865
Mailing Address - Country:US
Mailing Address - Phone:949-278-2207
Mailing Address - Fax:
Practice Address - Street 1:1700 ADAMS AVE STE 104
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4865
Practice Address - Country:US
Practice Address - Phone:714-545-0429
Practice Address - Fax:714-545-0420
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice