Healthcare Provider Details

I. General information

NPI: 1780655530
Provider Name (Legal Business Name): RAYMON P GREWAL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 S MINNESOTA AVE
SIOUX FALLS SD
57108-2504
US

IV. Provider business mailing address

6401 S MINNESOTA AVE
SIOUX FALLS SD
57108-2504
US

V. Phone/Fax

Practice location:
  • Phone: 605-335-1080
  • Fax:
Mailing address:
  • Phone: 605-335-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD0506
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: