Healthcare Provider Details

I. General information

NPI: 1730520214
Provider Name (Legal Business Name): HARNEET GREWAL BDS,DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

1500 E. MEDICAL CENTER DR.
ANN ARBOR MI
48109-0018
US

V. Phone/Fax

Practice location:
  • Phone: 734-647-8091
  • Fax: 734-647-8090
Mailing address:
  • Phone: 734-936-5950
  • Fax: 734-936-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN1856328
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: