Provider Demographics
NPI:1801248950
Name:BABAN DHARIWAL DDS PA INC
Entity type:Organization
Organization Name:BABAN DHARIWAL DDS PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-298-7345
Mailing Address - Street 1:6049 DOUGLAS BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6249
Mailing Address - Country:US
Mailing Address - Phone:916-791-4133
Mailing Address - Fax:
Practice Address - Street 1:5280 DOUGLAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6205
Practice Address - Country:US
Practice Address - Phone:916-800-5001
Practice Address - Fax:916-791-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty