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General NPI Number Information
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NPI Number | 1144928276
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Entity Type | Organization
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Legal Business Name | DHALIWAL AND DHALIWAL DDS, PLLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 03/12/2023
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Provider Practice Location Address
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Address Line | 17327 SE 270TH PL STE B113
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City | COVINGTON
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State | WA
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Zip | 98042-5451
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Country | US
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Telephone | 253-854-2714
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Fax |
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Provider Business Mailing Address
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Address Line | 10725 SE 256TH ST STE 1
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City | KENT
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State | WA
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Zip | 98030-8285
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Country | US
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Telephone | 253-854-2714
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JUDY REIS
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Credential |
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Telephone | 206-375-8926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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