Healthcare Provider Details

I. General information

NPI: 1316485741
Provider Name (Legal Business Name): PARADISE HILLS FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD NW, C-3
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

717 ENCINO PL NE, STE 6
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-200-0187
  • Fax:
Mailing address:
  • Phone: 505-200-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4182
License Number StateNM

VIII. Authorized Official

Name: KAPIL GREWAL
Title or Position: PRESIDENT
Credential: DDS
Phone: 505-200-0187