Provider Demographics
NPI:1295902401
Name:DHALIWAL, KRISTY (DDS)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:DHALIWAL
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 1:166 S CEDAR BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0468
Mailing Address - Country:US
Mailing Address - Phone:303-473-0541
Mailing Address - Fax:
Practice Address - Street 1:1001 NORTH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3308
Practice Address - Country:US
Practice Address - Phone:303-447-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice