=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811027261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANPREET GOSAL GREWAL DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 10/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5460 ORANGE AVENUE
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90630-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-226-9630
-----------------------------------------------------
Fax | 714-226-0190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5440 CASTLE BEND WAY
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92887-4254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-226-9630
-----------------------------------------------------
Fax | 714-226-0190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 45866
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------