Healthcare Provider Details

I. General information

NPI: 1225903560
Provider Name (Legal Business Name): P GREWAL DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 CHINO HILLS PKWY STE 805
CHINO HILLS CA
91709-3785
US

IV. Provider business mailing address

4200 CHINO HILLS PKWY STE 805
CHINO HILLS CA
91709-3785
US

V. Phone/Fax

Practice location:
  • Phone: 909-606-0160
  • Fax:
Mailing address:
  • Phone: 909-606-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. PRABHDEEP GREWAL
Title or Position: OWNER
Credential: DDS
Phone: 916-502-3150