=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295158517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DHILLON DENTAL CARE L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2014
-----------------------------------------------------
Last Update Date | 01/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18660 BAGLEY ROAD MEDICAL BLDG 2 SUITE 304
-----------------------------------------------------
City | MIDDLEBURG HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-826-0423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18660 BAGLEY ROAD MEDICAL BLDG 2 SUITE 304
-----------------------------------------------------
City | MIDDLEBURG HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-826-0423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AZALPREET KAUR DHILLON
-----------------------------------------------------
Credential | B.D.S
-----------------------------------------------------
Telephone | 440-826-0423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 30.023838
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------