Provider Demographics
NPI:1033899752
Name:BRAR, RANDEEP KAUR (DMD)
Entity Type:Individual
Prefix:
First Name:RANDEEP
Middle Name:KAUR
Last Name:BRAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18713 131ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7936
Mailing Address - Country:US
Mailing Address - Phone:929-391-3719
Mailing Address - Fax:
Practice Address - Street 1:18713 131ST AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7936
Practice Address - Country:US
Practice Address - Phone:929-391-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61447085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist