Provider Demographics
NPI:1275722779
Name:GREWAL, JASKIRAN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASKIRAN
Middle Name:K
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 1:1108 WARD AVE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-8529
Mailing Address - Country:US
Mailing Address - Phone:209-895-5440
Mailing Address - Fax:209-895-5441
Practice Address - Street 1:1108 WARD AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8529
Practice Address - Country:US
Practice Address - Phone:209-895-5440
Practice Address - Fax:209-895-5441
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist