Healthcare Provider Details

I. General information

NPI: 1033899752
Provider Name (Legal Business Name): RANDEEP KAUR BRAR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 119TH ST
COLLEGE POINT NY
11356-2120
US

IV. Provider business mailing address

1821 119TH ST
COLLEGE POINT NY
11356-2120
US

V. Phone/Fax

Practice location:
  • Phone: 929-391-3719
  • Fax:
Mailing address:
  • Phone: 929-391-3719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61447085
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: