Provider Demographics
NPI:1952993719
Name:SEMINOLE DENTAL
Entity type:Organization
Organization Name:SEMINOLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARABJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-438-5824
Mailing Address - Street 1:4002 LAKE POWELL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 HOBBS HWY
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3401
Practice Address - Country:US
Practice Address - Phone:650-438-5824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty