Provider Demographics
NPI:1467893636
Name:DHALIWAL, VISHAWDEEP SINGH (BDS)
Entity Type:Individual
Prefix:DR
First Name:VISHAWDEEP
Middle Name:SINGH
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BLYTH BOULVARD
Mailing Address - Street 2:CMC DENTAL CLINIC
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5812
Mailing Address - Country:US
Mailing Address - Phone:704-355-2165
Mailing Address - Fax:704-355-8856
Practice Address - Street 1:1222 JEFFERSON PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-5812
Practice Address - Country:US
Practice Address - Phone:434-924-1774
Practice Address - Fax:434-243-6378
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC151030122300000X
VA0401415518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist