Provider Demographics
NPI:1740535517
Name:GREWAL, SARABJEET KAUR (DDS)
Entity type:Individual
Prefix:
First Name:SARABJEET
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 1:101 SEAGRAVES RD
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-5447
Mailing Address - Country:US
Mailing Address - Phone:806-636-5555
Mailing Address - Fax:
Practice Address - Street 1:101 SEAGRAVES RD
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-5447
Practice Address - Country:US
Practice Address - Phone:806-636-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX299950006Medicaid