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General NPI Number Information
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NPI Number | 1346832979
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Entity Type | Organization
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Legal Business Name | GURJIT RANDHAWA DENTAL, INC.
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Dates
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Enumeration Date | 02/04/2021
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 2643 APPIAN WAY STE B
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City | PINOLE
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State | CA
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Zip | 94564-2253
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Country | US
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Telephone | 510-758-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 2643 APPIAN WAY STE B
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City | PINOLE
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State | CA
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Zip | 94564-2253
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Country | US
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Telephone | 510-758-0900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GURJIT S 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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