Provider Demographics
NPI:1104065184
Name:MOLALLA DENTAL CLINIC P.C.
Entity type:Organization
Organization Name:MOLALLA DENTAL CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JATINDER
Authorized Official - Middle Name:SINGN
Authorized Official - Last Name:DHADLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-829-9734
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-0629
Mailing Address - Country:US
Mailing Address - Phone:503-829-9734
Mailing Address - Fax:503-829-9735
Practice Address - Street 1:175 GRANGE AVE
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038
Practice Address - Country:US
Practice Address - Phone:503-829-9734
Practice Address - Fax:877-247-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty