MEDICARE: P GREWAL DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1225903560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P GREWAL DDS INC

Provider Business Mailing Address
First Line	:	4200 CHINO HILLS PKWY STE 805
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3785
Country	:	US
Telephone Number	:	909-606-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 CHINO HILLS PKWY STE 805
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3785
Country	:	US
Telephone Number	:	909-606-0160
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PRABHDEEP GREWAL
Credential	:	DDS
Telephone Number	:	916-502-3150

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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