Provider Demographics
NPI:1316515182
Name:WALIA DENTAL CORPORATION
Entity type:Organization
Organization Name:WALIA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMANPREET
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-643-5757
Mailing Address - Street 1:3101 N TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-1717
Mailing Address - Country:US
Mailing Address - Phone:408-643-5757
Mailing Address - Fax:
Practice Address - Street 1:3101 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-1717
Practice Address - Country:US
Practice Address - Phone:408-643-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58823OtherDENTIST