Gagneet K Grewal, DDS
Individual provider Active NPI Dentist · Patterson, CA
NPI 1760953954 · NPPES record last updated Dec 16, 2018
Key facts
- NPI
- 1760953954
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DDS102719 (CA)
- Practice address
- 1108 Ward Ave Ste 10B
Patterson, CA 95363-8529 - Phone
- (209) 895-5440
- NPI assigned
- Dec 16, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS102719 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS102719 | CA | Yes |
Addresses
Primary practice location
1108 Ward Ave Ste 10B
Patterson, CA 95363-8529
Mailing address
2200 Standiford Ave Apt 253
Modesto, CA 95350-6544
Phone (408) 828-7443
Other providers in Patterson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.