Provider Demographics
NPI:1306200779
Name:BABAN DHARIWAL DDS PA INC
Entity Type:Organization
Organization Name:BABAN DHARIWAL DDS PA INC
Other - Org Name:SUNRISE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-693-4960
Mailing Address - Street 1:901 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4519
Mailing Address - Country:US
Mailing Address - Phone:916-693-4960
Mailing Address - Fax:
Practice Address - Street 1:158 RED RIDGE CT
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-7421
Practice Address - Country:US
Practice Address - Phone:916-693-4960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental