Provider Demographics
NPI:1053082156
Name:BALJIT DHILLON DDS INC
Entity Type:Organization
Organization Name:BALJIT DHILLON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BALJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-824-2869
Mailing Address - Street 1:93 MORAGA WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3036
Mailing Address - Country:US
Mailing Address - Phone:925-253-0165
Mailing Address - Fax:
Practice Address - Street 1:93 MORAGA WAY STE 201
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3036
Practice Address - Country:US
Practice Address - Phone:925-253-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental