Provider Demographics
NPI:1366280125
Name:DHALIWAL, AVNEET KAUR (DMD)
Entity type:Individual
Prefix:DR
First Name:AVNEET
Middle Name:KAUR
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13309 SE 261ST PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3507
Mailing Address - Country:US
Mailing Address - Phone:253-391-9648
Mailing Address - Fax:
Practice Address - Street 1:5712 E LAKE SAMMAMISH PKWY SE STE 108
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8943
Practice Address - Country:US
Practice Address - Phone:425-392-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61562458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist