Provider Demographics
NPI:1740594571
Name:DHILLON, INDERRAJ (DDS)
Entity Type:Individual
Prefix:DR
First Name:INDERRAJ
Middle Name:
Last Name:DHILLON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 W 17TH AVE # 105
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3619
Mailing Address - Country:US
Mailing Address - Phone:458-210-3543
Mailing Address - Fax:
Practice Address - Street 1:1740 W 17TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3619
Practice Address - Country:US
Practice Address - Phone:458-210-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008567122300000X
DEG3-00003781223S0112X
ORD110201223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery