Individual
DR. AVTAR S. GREWAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3533 N SHILOH DR STE 3, FAYETTEVILLE, AR 72703-5317
(479) 442-3411
(479) 442-3901
Mailing address
3533 N SHILOH DR STE 3, FAYETTEVILLE, AR 72703-5317
(479) 442-3411
(479) 442-3901
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3589
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1892010
UNITED CONCORDIA
AR
01
—
5P029
BCBS
AR
Enumeration date
12/13/2006
Last updated
07/08/2007
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