MEDICARE: MS. SANDEEP RANDHAWA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	060517	NY

General Provider Information

NPI Number	:	1386137263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDEEP RANDHAWA DDS

Provider Business Mailing Address
First Line	:	9323 AVENUE L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4806
Country	:	US
Telephone Number	:	718-763-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	9323 AVENUE L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4806
Country	:	US
Telephone Number	:	718-763-0505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	11/25/2019

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