Provider Demographics
NPI:1356515894
Name:DHALIWAL, MANJOTE KAUR (DDS)
Entity type:Individual
Prefix:MS
First Name:MANJOTE
Middle Name:KAUR
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 1:7671 QUARTERFIELD RD STE 400
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4981
Mailing Address - Country:US
Mailing Address - Phone:410-670-4525
Mailing Address - Fax:
Practice Address - Street 1:7671 QUARTERFIELD RD STE 400
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4981
Practice Address - Country:US
Practice Address - Phone:410-670-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0023801223P0221X
MD157481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry