Provider Demographics
NPI:1578804050
Name:MANN-GREWAL, HARLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARLEEN
Middle Name:
Last Name:MANN-GREWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HARLEEN
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4255 N GOLDEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6774
Mailing Address - Country:US
Mailing Address - Phone:213-804-5535
Mailing Address - Fax:
Practice Address - Street 1:755 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-265-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry