Provider Demographics
NPI:1528885662
Name:GREWAL, JASPREET KAUR (DDS)
Entity type:Individual
Prefix:
First Name:JASPREET
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 1:2805 JACK RABBIT WAY
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-2036
Mailing Address - Country:US
Mailing Address - Phone:949-228-8090
Mailing Address - Fax:
Practice Address - Street 1:3030 LBJ FWY STE 1700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2759
Practice Address - Country:US
Practice Address - Phone:949-228-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX410001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice