Provider Demographics
NPI:1184850182
Name:GREWAL, REENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REENA
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 1:7350 COLDSPRING LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4213
Mailing Address - Country:US
Mailing Address - Phone:248-808-5059
Mailing Address - Fax:
Practice Address - Street 1:5475 DAVISON RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1520
Practice Address - Country:US
Practice Address - Phone:810-736-9778
Practice Address - Fax:810-736-3269
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI200311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice