Healthcare Provider Details

I. General information

NPI: 1801248950
Provider Name (Legal Business Name): BABAN DHARIWAL DDS PA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 DOUGLAS BLVD STE 100
GRANITE BAY CA
95746-6205
US

IV. Provider business mailing address

6049 DOUGLAS BLVD STE 9
ROSEVILLE CA
95746-6249
US

V. Phone/Fax

Practice location:
  • Phone: 916-800-5001
  • Fax: 916-791-1659
Mailing address:
  • Phone: 916-791-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BABAN DHARIWAL
Title or Position: PRESIDENT
Credential: DDS
Phone: 916-298-7345