Healthcare Provider Details

I. General information

NPI: 1073283750
Provider Name (Legal Business Name): MUHAMMAD RANDHAWA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7206 HUGHSON AVE
HUGHSON CA
95326
US

IV. Provider business mailing address

PO BOX 1026
HUGHSON CA
95326-1026
US

V. Phone/Fax

Practice location:
  • Phone: 209-883-4477
  • Fax: 209-883-4499
Mailing address:
  • Phone: 209-883-4477
  • Fax: 209-883-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MUHAMMAD A RANDHAWA
Title or Position: CEO
Credential: DDS
Phone: 209-883-4477