Provider Demographics
NPI:1295990638
Name:GREWAL, SONIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3939
Mailing Address - Country:US
Mailing Address - Phone:719-336-0261
Mailing Address - Fax:719-336-0261
Practice Address - Street 1:200 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3940
Practice Address - Country:US
Practice Address - Phone:719-336-0261
Practice Address - Fax:719-336-0265
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92428363Medicaid
COFG1041134OtherDEA