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General NPI Number Information
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NPI Number | 1619477254
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Entity Type | Organization
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Legal Business Name | RAJU DHARIWAL D.D.S INC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 9170 ELK GROVE FLORIN RD STE D
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City | ELK GROVE
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State | CA
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Zip | 95624-4043
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Country | US
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Telephone | 916-753-3510
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Fax |
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Provider Business Mailing Address
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Address Line | 9960 SINTRA WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-6341
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Country | US
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Telephone | 916-753-3510
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJU DHARIWAL
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Credential |
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Telephone | 916-753-3510
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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 | 61098
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License Number State | CA
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