Provider Demographics
NPI:1043449945
Name:RANDHAWA, MANDEEP SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:SINGH
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 ALDERBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1382
Mailing Address - Country:US
Mailing Address - Phone:916-813-7682
Mailing Address - Fax:
Practice Address - Street 1:2205 FRANCISCO DR STE 150
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3943
Practice Address - Country:US
Practice Address - Phone:916-934-0207
Practice Address - Fax:916-934-0214
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice