Provider Demographics
NPI:1194274803
Name:DHILLON, HARDEV SINGH
Entity type:Individual
Prefix:
First Name:HARDEV
Middle Name:SINGH
Last Name:DHILLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 36TH ST
Mailing Address - Street 2:152 STREET
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6540
Mailing Address - Country:CA
Mailing Address - Phone:778-855-1780
Mailing Address - Fax:
Practice Address - Street 1:224 26TH STREET
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-547-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606779121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice