Provider Demographics
NPI:1134590417
Name:GREWAL, SUKHMANI (DDS)
Entity type:Individual
Prefix:
First Name:SUKHMANI
Middle Name:
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 1:20 NEWPORT PKWY APT 903
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2304
Mailing Address - Country:US
Mailing Address - Phone:617-599-7398
Mailing Address - Fax:
Practice Address - Street 1:1152 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2045
Practice Address - Country:US
Practice Address - Phone:617-599-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02616700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist