MEDICARE: GURBIR SINGH DHALIWAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	109330	CA

General Provider Information

NPI Number	:	1801673215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GURBIR SINGH DHALIWAL

Provider Business Mailing Address
First Line	:	4560 WHITE SAGE ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-2487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 BRONZE STAR DR
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-5427
Country	:	US
Telephone Number	:	530-662-7592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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