Provider Demographics
NPI:1831554989
Name:KAPIL GREWAL DDS
Entity type:Organization
Organization Name:KAPIL GREWAL DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAPIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-490-7704
Mailing Address - Street 1:717 ENCINO PL NE STE 6
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2624
Mailing Address - Country:US
Mailing Address - Phone:505-247-8005
Mailing Address - Fax:
Practice Address - Street 1:717 ENCINO PL NE STE 6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2624
Practice Address - Country:US
Practice Address - Phone:505-247-8005
Practice Address - Fax:505-843-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD41821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty