MEDICARE: DR. JASKIRAN K GREWAL D.D.S

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	122300000X	Dentist	53993	CA

General Provider Information

NPI Number	:	1275722779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASKIRAN K GREWAL D.D.S

Provider Business Mailing Address
First Line	:	1108 WARD AVE
Second Line	:	SUITE #10
City	:	PATTERSON
State	:	CA
Zip	:	95363-8529
Country	:	US
Telephone Number	:	209-895-5440
Fax Number	:	209-895-5441

Provider Business Practice Location Address
First Line	:	1108 WARD AVE
Second Line	:	SUITE #10
City	:	PATTERSON
State	:	CA
Zip	:	95363-8529
Country	:	US
Telephone Number	:	209-895-5440
Fax Number	:	209-895-5441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2007
Last Update Date	:	10/20/2007

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