MEDICARE: DR. RAMANPREET KAUR RANDHAWA-KOHLI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN27364	FL

General Provider Information

NPI Number	:	1245951821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMANPREET KAUR RANDHAWA-KOHLI DDS

Provider Business Mailing Address
First Line	:	2075 S PALMETTO AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-2224
Country	:	US
Telephone Number	:	386-383-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 S RIDGEWOOD AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4928
Country	:	US
Telephone Number	:	386-255-8866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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