Provider Demographics
NPI:1861621641
Name:GREWAL, AMAN K (DDS,MDS,BDS)
Entity type:Individual
Prefix:DR
First Name:AMAN
Middle Name:K
Last Name:GREWAL
Suffix:
Gender:F
Credentials:DDS,MDS,BDS
Other - Prefix:DR
Other - First Name:AMAN
Other - Middle Name:K
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MDS,BDS
Mailing Address - Street 1:637 HICKORY ST NW STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1761
Mailing Address - Country:US
Mailing Address - Phone:541-406-3500
Mailing Address - Fax:
Practice Address - Street 1:637 HICKORY ST NW STE 110
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1761
Practice Address - Country:US
Practice Address - Phone:541-406-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190280521223G0001X
ORD108091223G0001X
CODEN-103251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY130509300Medicaid
NE1861621641Medicaid
CO82673551Medicaid