Provider Demographics
NPI:1881897999
Name:THE GREENAWALT DHALIWAL LLP
Entity type:Organization
Organization Name:THE GREENAWALT DHALIWAL LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENAWALT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-698-9335
Mailing Address - Street 1:P.O. BOX 3770
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-698-9335
Mailing Address - Fax:360-698-9385
Practice Address - Street 1:2021 NW MYHRE RD
Practice Address - Street 2:#210
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-698-9335
Practice Address - Fax:360-698-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA80801223S0112X
WA67141223S0112X
WA69511223S0112X
WADE600168241223S0112X
WA204E00000X
WADE80801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115138700OtherMEDICARE ID #
WA115138700OtherMEDICARE ID #
WAU71903Medicare UPIN