Provider Demographics
NPI:1437284478
Name:DHALIWAL, GURI S (DMD)
Entity Type:Individual
Prefix:DR
First Name:GURI
Middle Name:S
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18080 SAN RAMON VALLEY BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4434
Mailing Address - Country:US
Mailing Address - Phone:925-244-9770
Mailing Address - Fax:925-244-9774
Practice Address - Street 1:18080 SAN RAMON VALLEY BLVD STE 108
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4434
Practice Address - Country:US
Practice Address - Phone:925-244-9770
Practice Address - Fax:925-244-9774
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41009OtherSTATE LICENSE NUMBER