Provider Demographics
NPI:1487860862
Name:GREWAL, PRIYA BALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:BALI
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 1:5113 DUNSTER DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8883
Mailing Address - Country:US
Mailing Address - Phone:571-216-6892
Mailing Address - Fax:
Practice Address - Street 1:1900 N BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1437
Practice Address - Country:US
Practice Address - Phone:770-916-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110431223G0001X
TX23631122300000X
MD147091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist