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General NPI Number Information
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NPI Number | 1528254851
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Entity Type | Organization
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Legal Business Name | INNOVATIVE DENTISTRY, P.C.
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 546 SAINT GEORGES AVE
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City | RAHWAY
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State | NJ
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Zip | 07065-2542
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Country | US
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Telephone | 732-882-1700
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Fax | 732-882-1799
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Provider Business Mailing Address
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Address Line | 546 SAINT GEORGES AVE
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City | RAHWAY
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State | NJ
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Zip | 07065-2542
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Country | US
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Telephone | 732-882-1700
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Fax | 732-882-1799
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RAJDEEP SINGH RANDHAWA
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Credential | D.D.S.
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Telephone | 732-882-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02201400
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License Number State | NJ
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