Basic Information
| Provider Information | |||||||||
| NPI: | 1003365057 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DHILLONDENTA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 414 MILLBROOK CT | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956483250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168720737 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 414 MILLBROOK CT | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956483250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168720737 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2016 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DHILLON | ||||||||
| AuthorizedOfficialFirstName: | RAJWINDER | ||||||||
| AuthorizedOfficialMiddleName: | SINGH | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 9168720737 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | 59097 | CA | N | Managed Care Organizations | Health Maintenance Organization | 122300000X | 59097 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.