Healthcare Provider Details

I. General information

NPI: 1467655548
Provider Name (Legal Business Name): THE GREENAWALT DHALIWAL LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19503 7TH AVE NE
POULSBO WA
98370
US

IV. Provider business mailing address

PO BOX 3770
SILVERDALE WA
98383
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-2339
  • Fax: 360-779-6475
Mailing address:
  • Phone: 360-698-9335
  • Fax: 360-698-9385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8080
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. PAUL B GREENAWAIT
Title or Position: PARTNER
Credential: DDS
Phone: 360-698-9335