Provider Demographics
NPI:1861642118
Name:GREWAL, JASMEEN KAUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASMEEN
Middle Name:KAUR
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 1:24300 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1935
Mailing Address - Country:US
Mailing Address - Phone:248-354-6364
Mailing Address - Fax:248-354-2486
Practice Address - Street 1:24300 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1935
Practice Address - Country:US
Practice Address - Phone:248-354-6364
Practice Address - Fax:248-354-2486
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020855122300000X
OH30-023674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist