Avtar S. Grewal, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

3589 Issued in AR

Practice address

3533 N Shiloh Dr Ste 3
Fayetteville, AR 72703-5317

Phone

(479) 442-3411

Fax

(479) 442-3901

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 6, 2016 through Apr 6, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235290115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3533 N SHILOH DR STE 3",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035317",
            "telephone_number": "479-442-3411",
            "fax_number": "479-442-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 N SHILOH DR STE 3",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035317",
            "telephone_number": "479-442-3411",
            "fax_number": "479-442-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREWAL",
        "first_name": "AVTAR",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AR",
            "license": "3589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1892010",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5P029",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitney Kaye Greenlee
• Alaina Greewood, LPC
• Caitlin Paige Gregory, M.S.
• Teresa Gregory
• Valerie Grevers, DC
• Grey Fox Anesthesia, P.a.
• Mike Anthony Griffey, MD
• Danielle Griffin, APRN
• Jared Neal Griffin, PT
• Michele L Griffin, NP-C

• Orthodontics and Dentofacial Orthopedics Dentistry in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.