Provider Demographics
NPI:1194908103
Name:GREWAL, VIRINDER S (DMD)
Entity type:Individual
Prefix:DR
First Name:VIRINDER
Middle Name:S
Last Name:GREWAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9571 LAGUNA SPRINGS DR
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7961
Mailing Address - Country:US
Mailing Address - Phone:916-683-1800
Mailing Address - Fax:916-683-1890
Practice Address - Street 1:9571 LAGUNA SPRINGS DR
Practice Address - Street 2:SUITE # 100
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7961
Practice Address - Country:US
Practice Address - Phone:916-683-1800
Practice Address - Fax:916-683-1890
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice