Provider Demographics
NPI:1881805778
Name:DHALIWAL, GURSHARAN SINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:GURSHARAN
Middle Name:SINGH
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13955 INTERURBAN AVE S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4721
Mailing Address - Country:US
Mailing Address - Phone:206-431-0953
Mailing Address - Fax:206-439-6860
Practice Address - Street 1:13955 INTERURBAN AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4721
Practice Address - Country:US
Practice Address - Phone:206-431-0953
Practice Address - Fax:206-439-6860
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000093961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice