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General NPI Number Information
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NPI Number | 1306594312
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Entity Type | Organization
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Legal Business Name | GURJIT S RANDHWA DDS, INC.
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 2229 SANTA CLARA AVE STE E
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City | ALAMEDA
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State | CA
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Zip | 94501-4409
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Country | US
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Telephone | 510-521-3300
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Fax | 510-521-3301
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Provider Business Mailing Address
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Address Line | 2229 SANTA CLARA AVE STE E
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City | ALAMEDA
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State | CA
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Zip | 94501-4409
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Country | US
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Telephone | 510-521-3300
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Fax | 510-521-3301
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Authorized Official
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Title or Position | PRESIDENT
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Name | GURJIT RANDHAWA
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Credential | DDS,DMD
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Telephone | 510-220-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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