Provider Demographics
NPI:1265640379
Name:RANDHAWA, GURJIT SINGH (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:GURJIT
Middle Name:SINGH
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 SANTA CLARA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4409
Mailing Address - Country:US
Mailing Address - Phone:510-521-3300
Mailing Address - Fax:
Practice Address - Street 1:2229 SANTA CLARA AVE STE E
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4409
Practice Address - Country:US
Practice Address - Phone:510-521-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46941122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice