Individual provider Active NPI

Paul Grewal, DDS

  • General Practice Dentistry
  • Riverside, CA
National Provider Identifier
1669650776
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
40939 Issued in CA
Practice address
6860 Brockton Ave Ste 3
Riverside, CA 92506-3816
Phone
(951) 686-9255
Fax
(951) 686-3141
NPI assigned
Jan 31, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 40939 CA Primary

Addresses

Primary practice location

6860 Brockton Ave Ste 3
Riverside, CA 92506-3816

Mailing address

6860 Brockton Ave Ste 3
Riverside, CA 92506-3816
Phone (951) 686-9255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240822000449 CA Practitioner - Dentist 2466991484 Practice locations: Riverside, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1669650776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6860 BROCKTON AVE STE 3",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063816",
            "telephone_number": "951-686-9255",
            "fax_number": "951-686-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6860 BROCKTON AVE STE 3",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063816",
            "telephone_number": "951-686-9255",
            "fax_number": "951-686-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREWAL",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.