Provider Demographics
NPI:1083021323
Name:DHILLON, MANINDER KAUR (DDS)
Entity Type:Individual
Prefix:
First Name:MANINDER
Middle Name:KAUR
Last Name:DHILLON
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 1:605 STANDIFORD AVE STE G
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1000
Mailing Address - Country:US
Mailing Address - Phone:209-633-1200
Mailing Address - Fax:
Practice Address - Street 1:1912 STANDIFORD AVE STE 1
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6507
Practice Address - Country:US
Practice Address - Phone:209-522-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA63616OtherSTATE DENTAL BOARD OF CALIFORNIA