Healthcare Provider Details

I. General information

NPI: 1144928276
Provider Name (Legal Business Name): DHALIWAL AND DHALIWAL DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 03/12/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17327 SE 270TH PL STE B113
COVINGTON WA
98042-5451
US

IV. Provider business mailing address

10725 SE 256TH ST STE 1
KENT WA
98030-8285
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-2714
  • Fax:
Mailing address:
  • Phone: 253-854-2714
  • 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: JUDY REIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 206-375-8926