Provider Demographics
NPI:1245960210
Name:GREWAL, KARUN BIR (DDS)
Entity type:Individual
Prefix:DR
First Name:KARUN
Middle Name:BIR
Last Name:GREWAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONTAGNA CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2668
Mailing Address - Country:US
Mailing Address - Phone:916-300-9892
Mailing Address - Fax:
Practice Address - Street 1:301 W STATE HIGHWAY 71 STE 200
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4111
Practice Address - Country:US
Practice Address - Phone:512-321-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice