Healthcare Provider Details

I. General information

NPI: 1285551945
Provider Name (Legal Business Name): KHALSA KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD STE 106
GILBERT AZ
85297-1507
US

IV. Provider business mailing address

8103 E PALOMA AVE
MESA AZ
85212-9052
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-4636
  • Fax:
Mailing address:
  • Phone: 480-290-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HAPPY GREWAL
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 480-290-8428