Provider Demographics
NPI:1083148308
Name:NORTHWEST MAXILLOFACIAL AND COSMETIC SURGERY ASSOCIATES PS
Entity Type:Organization
Organization Name:NORTHWEST MAXILLOFACIAL AND COSMETIC SURGERY ASSOCIATES PS
Other - Org Name:ADARA SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:425-332-5333
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:425-332-5333
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603839211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty