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General NPI Number Information
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NPI Number | 1104519495
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Entity Type | Organization
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Legal Business Name | DHILLON DENTAL PLLC
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 1101 STEWART AVE STE 104
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City | GARDEN CITY
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State | NY
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Zip | 11530-4808
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Country | US
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Telephone | 804-513-4926
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Fax |
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Provider Business Mailing Address
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Address Line | 2 GOLD ST APT 4305
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City | NEW YORK
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State | NY
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Zip | 10038-4864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MANPREET KAUR DHILLON
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Credential | DDS
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Telephone | 804-513-4926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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