MEDICARE: DR. GURJIT SINGH RANDHAWA D.D.S., M.D.S.

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	122300000X	Dentist	46941	CA
2	1223G0001X	General Practice Dentistry	46941	CA

General Provider Information

NPI Number	:	1265640379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GURJIT SINGH RANDHAWA D.D.S., M.D.S.

Provider Business Mailing Address
First Line	:	2229 SANTA CLARA AVE STE E
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4409
Country	:	US
Telephone Number	:	510-521-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 SANTA CLARA AVE STE E
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4409
Country	:	US
Telephone Number	:	510-521-3300
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	01/22/2020

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