Healthcare Provider Details

I. General information

NPI: 1811163611
Provider Name (Legal Business Name): HARDEEP DHALIWAL MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 226TH PL SE STE 100
ISSAQUAH WA
98027-8905
US

IV. Provider business mailing address

6505 226TH PL SE STE 100
ISSAQUAH WA
98027-8905
US

V. Phone/Fax

Practice location:
  • Phone: 425-332-5333
  • Fax: 425-332-5332
Mailing address:
  • Phone: 254-332-5333
  • Fax: 425-332-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberGA60383740
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60377088
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD60383921
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDE60377088
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD60383921
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: