Provider Demographics
NPI:1619477254
Name:RAJU DHARIWAL D.D.S INC
Entity Type:Organization
Organization Name:RAJU DHARIWAL D.D.S INC
Other - Org Name:CAMDEN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-753-3510
Mailing Address - Street 1:9960 SINTRA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6341
Mailing Address - Country:US
Mailing Address - Phone:916-753-3510
Mailing Address - Fax:
Practice Address - Street 1:9170 ELK GROVE FLORIN RD STE D
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4043
Practice Address - Country:US
Practice Address - Phone:916-753-3510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61098261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental