Provider Demographics
NPI:1720626435
Name:DHALIWAL, MANRAJ K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANRAJ
Middle Name:K
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 1:5040 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3909
Mailing Address - Country:US
Mailing Address - Phone:510-926-2727
Mailing Address - Fax:
Practice Address - Street 1:6660 LONE TREE WAY STE 7
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5310
Practice Address - Country:US
Practice Address - Phone:925-513-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1045971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice