Healthcare Provider Details

I. General information

NPI: 1760744734
Provider Name (Legal Business Name): RATANDEEP KAUR BAWA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 260
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR STE 260
FOOTHILL RANCH CA
92610-2844
US

V. Phone/Fax

Practice location:
  • Phone: 949-273-8600
  • Fax: 949-273-8601
Mailing address:
  • Phone: 949-273-8600
  • Fax: 949-273-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54092
License Number StateCA

VIII. Authorized Official

Name: RATANDEEP KAUR BAWA
Title or Position: PRESIDENT
Credential: DDS
Phone: 949-273-8600