Individual provider Active NPI

Manpreet Singh Dhaliwal, DDS

  • Dentist
  • Kent, WA
National Provider Identifier
1114208782
Registry record updated Jul 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE60243483 Issued in WA
Practice address
10725 SE 256TH St
Suite 1
Kent, WA 98030-8285
Phone
(206) 349-3857
NPI assigned
Sep 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901020435 MI
Dentist 122300000X DE60243483 WA Primary

Addresses

Primary practice location

10725 SE 256TH St
Suite 1
Kent, WA 98030-8285

Mailing address

12309 SE 314TH PL
Auburn, WA 98092-0986
Phone (206) 349-3857

Other identifiers 1

IdentifierTypeStateIssuer
2024505MedicaidWA

Other names 1

  • Dr. Manpreet Singh Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DE60243483WAMDDentist
2901020435MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Navdeep Dhaliwal and Manpreet Dhaliwal DDS PLLC General Practice CurrentSince Dec 29, 2024 Accepting new patients
Dhaliwal, DDS, PLLC General Practice Past Accepting new patients
Dhaliwal and Dhaliwal DDS, PLLC General Practice PastSince Feb 19, 2023 Accepting new patients

Locations

1006 Fryar Ave
Ste A
Sumner, WA 98390
Phone (253) 299-9211

Organizations & group practices 3

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": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469404800000",
    "number": "1114208782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12309 SE 314TH PL",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980920986",
            "telephone_number": "206-349-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10725 SE 256TH ST",
            "address_2": "SUITE 1",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980308285",
            "telephone_number": "206-349-3857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DHALIWAL",
        "first_name": "MANPREET",
        "middle_name": "SINGH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-08",
        "last_updated": "2016-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020435",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60243483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2024505",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANPREET",
            "last_name": "SINGH",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.