Provider Demographics
NPI:1588672968
Name:GREWAL, DEEPINDER SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEEPINDER
Middle Name:SINGH
Last Name:GREWAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5435
Mailing Address - Country:US
Mailing Address - Phone:559-457-5345
Mailing Address - Fax:559-457-5395
Practice Address - Street 1:2756 S ELM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5435
Practice Address - Country:US
Practice Address - Phone:559-457-5345
Practice Address - Fax:559-457-5395
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211751223G0001X
IL0190261051223G0001X
AK11431223G0001X
CA568901223G0001X
AZ57901223G0001X
WADE 000094991223G0001X
IA087061223G0001X
WI5673-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice