Provider Demographics
NPI:1366760704
Name:DHIR, KOMAL (DDS)
Entity type:Individual
Prefix:MR
First Name:KOMAL
Middle Name:
Last Name:DHIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 PEACE PORTAL DR
Mailing Address - Street 2:107-440
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4016
Mailing Address - Country:US
Mailing Address - Phone:415-652-8972
Mailing Address - Fax:
Practice Address - Street 1:4291 GUIDE MERIDIAN
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6482
Practice Address - Country:US
Practice Address - Phone:360-715-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60105525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist