Provider Demographics
NPI:1548082282
Name:ATHWAL, HARLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:HARLEEN
Middle Name:
Last Name:ATHWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ADMIRAL DR UNIT 445
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1591
Mailing Address - Country:US
Mailing Address - Phone:734-741-3586
Mailing Address - Fax:
Practice Address - Street 1:852 REICHERT AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4124
Practice Address - Country:US
Practice Address - Phone:415-891-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1109531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice