Provider Demographics
NPI:1811027261
Name:GREWAL, MANPREET GOSAL (DDS)
Entity Type:Individual
Prefix:
First Name:MANPREET
Middle Name:GOSAL
Last Name:GREWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MANPREET
Other - Middle Name:
Other - Last Name:GOSAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5440 CASTLE BEND WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4254
Mailing Address - Country:US
Mailing Address - Phone:714-226-9630
Mailing Address - Fax:714-226-0190
Practice Address - Street 1:5460 ORANGE AVENUE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3740
Practice Address - Country:US
Practice Address - Phone:714-226-9630
Practice Address - Fax:714-226-0190
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist