Gursimran Singh Grewal, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D012960 Issued in AZ

Practice address

7584 E State Route 69
Prescott Valley, AZ 86314-2278

Phone

(928) 499-3061

NPI assigned

May 31, 2023

Reactivated

Sep 3, 2026

Last updated

Sep 13, 2026By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spark Dentistry PLLC

  • General Practice Dentistry
  • Prescott Valley, AZ
  • NPI 1073234241
  NPD (past)

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789257600000",
    "number": "1336832823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7584 E STATE ROUTE 69",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142278",
            "telephone_number": "928-499-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7584 E STATE ROUTE 69",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142278",
            "telephone_number": "928-499-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREWAL",
        "first_name": "GURSIMRAN",
        "middle_name": "SINGH",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-31",
        "last_updated": "2026-09-13",
        "certification_date": "2026-09-13",
        "deactivation_date": "2024-04-10",
        "reactivation_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D012960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Howard Greene, O.D.
• Virginia I Greene, FNP
• Carla L Greenwood, LPC
• Christopher Gregory, PHARMD
• Gayle L Gregory, MD
• Yvette Dawn Grijalva, FNP-C
• Leeann Rene Groveunder, FNP-C
• Madelynn Grubbs
• Anita Marilyn Gunnufson, RNP
• H&M Rogers, LLC

• General Practice Dentistry in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.