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General NPI Number Information
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NPI Number | 1134524168
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Entity Type | Organization
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Legal Business Name | TOOTHPIK PLLC
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 10842 POTRANCO RD 115
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3307
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Country | US
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Telephone | 210-607-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 8725 MARBACH RD 237
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City | SAN ANTONIO
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State | TX
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Zip | 78227-2376
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Country | US
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Telephone | 210-627-6305
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Fax |
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Authorized Official
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Title or Position | OWENER
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Name | DR. PRABHDEEP GREWAL
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Credential | DDS
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Telephone | 210-607-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27735
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License Number State | TX
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