Provider Demographics
NPI:1144396763
Name:DHALIWAL, SUKHDEEP SINGH (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:SUKHDEEP
Middle Name:SINGH
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:MD, DDS
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Mailing Address - Street 1:2021 NW MYHRE RD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8562
Mailing Address - Country:US
Mailing Address - Phone:360-698-9335
Mailing Address - Fax:360-698-9385
Practice Address - Street 1:19503 7TH AVE NE # 100
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7529
Practice Address - Country:US
Practice Address - Phone:360-779-2339
Practice Address - Fax:360-779-6475
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA600168241223S0112X
WA60027252204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery