Provider Demographics
NPI:1114208782
Name:DHALIWAL, MANPREET SINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:MANPREET
Middle Name:SINGH
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MANPREET
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12309 SE 314TH PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-0986
Mailing Address - Country:US
Mailing Address - Phone:206-349-3857
Mailing Address - Fax:
Practice Address - Street 1:10725 SE 256TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-8285
Practice Address - Country:US
Practice Address - Phone:206-349-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010204351223G0001X
WADE60243483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024505Medicaid