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General NPI Number Information
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NPI Number | 1467893636
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Entity Type | Individual
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Provider Name | VISHAWDEEP SINGH DHALIWAL B.D.S
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Gender | Male
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 09/30/2018
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Provider Practice Location Address
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Address Line | 1222 JEFFERSON PARK AVE
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-5812
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Country | US
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Telephone | 434-924-1774
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Fax | 434-243-6378
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Provider Business Mailing Address
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Address Line | 1000 BLYTH BOULVARD CMC DENTAL CLINIC
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City | CHARLOTTE
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State | NC
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Zip | 28203-5812
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Country | US
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Telephone | 704-355-2165
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Fax | 704-355-8856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 151030
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401415518
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License Number State | VA
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