Provider Demographics
NPI:1871826289
Name:WALIA, SUMANPREET K (DDS)
Entity Type:Individual
Prefix:
First Name:SUMANPREET
Middle Name:K
Last Name:WALIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7469
Mailing Address - Country:US
Mailing Address - Phone:408-242-1440
Mailing Address - Fax:
Practice Address - Street 1:3526 MANTHEY RD
Practice Address - Street 2:SUITE H
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-5301
Practice Address - Country:US
Practice Address - Phone:209-983-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice