Individual provider Active NPI

Maninder Kaur Dhillon, DDS

  • Dentist
  • Modesto, CA
National Provider Identifier
1083021323
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
63616 Issued in CA
Practice address
1912 Standiford Ave Ste 1
Modesto, CA 95350-6507
Phone
(209) 522-6400
NPI assigned
Jul 18, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 63616 CA Primary

Addresses

Primary practice location

1912 Standiford Ave Ste 1
Modesto, CA 95350-6507

Mailing address

605 Standiford Ave Ste G
Modesto, CA 95350-1000
Phone (209) 633-1200

Other identifiers 1

IdentifierTypeStateIssuer
63616OtherCASTATE DENTAL BOARD OF CALIFORNIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160714000697 CA Order and Referring Only - DentistPractitioner - Dentist 4385936103

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rupinder Chahal DDS Inc Current Accepting new patients
Maninder Dhillon DDS Inc Current Accepting new patients

Locations

605 Standiford Ave
Ste G
Modesto, CA 95350
Phone (209) 222-0440

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1083021323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 STANDIFORD AVE STE G",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501000",
            "telephone_number": "209-633-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 STANDIFORD AVE STE 1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506507",
            "telephone_number": "209-522-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DHILLON",
        "first_name": "MANINDER",
        "middle_name": "KAUR",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-18",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL BOARD OF CALIFORNIA",
            "identifier": "63616",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.