Healthcare Provider Details

I. General information

NPI: 1508288424
Provider Name (Legal Business Name): MUHAMMAD A RANDHAWA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 HILLTOP DR
REDDING CA
96002-0240
US

IV. Provider business mailing address

1667 HILLTOP DR
REDDING CA
96002-0240
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: