Provider Demographics
NPI:1295158517
Name:DHILLON DENTAL CARE L.L.C
Entity type:Organization
Organization Name:DHILLON DENTAL CARE L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZALPREET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:440-826-0423
Mailing Address - Street 1:18660 BAGLEY ROAD
Mailing Address - Street 2:MEDICAL BLDG 2 SUITE 304
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-826-0423
Mailing Address - Fax:
Practice Address - Street 1:18660 BAGLEY ROAD
Practice Address - Street 2:MEDICAL BLDG 2 SUITE 304
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-826-0423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0238381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091963Medicaid