Provider Demographics
NPI:1811163611
Name:DHALIWAL, HARDEEP (MD, DMD)
Entity type:Individual
Prefix:
First Name:HARDEEP
Middle Name:
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 226TH PL SE STE 100
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8905
Mailing Address - Country:US
Mailing Address - Phone:254-332-5333
Mailing Address - Fax:425-332-5332
Practice Address - Street 1:6505 226TH PL SE STE 100
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8905
Practice Address - Country:US
Practice Address - Phone:425-332-5333
Practice Address - Fax:425-332-5332
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60383921204E00000X, 2086S0122X
WAGA603837401223D0004X
WADE60377088204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223D0004XDental ProvidersDentistDental Anesthesiology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery