Healthcare Provider Details

I. General information

NPI: 1558053116
Provider Name (Legal Business Name): TEJDEEP RATTAN D.D.S INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 CONCANNON BLVD
LIVERMORE CA
94550-6004
US

IV. Provider business mailing address

919 S FULTON ST
TRACY CA
95391-1402
US

V. Phone/Fax

Practice location:
  • Phone: 937-369-7843
  • Fax:
Mailing address:
  • Phone: 937-369-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TEJDEEP RATTAN
Title or Position: CEO/PRESIDENT
Credential: DDS
Phone: 937-369-7843