Provider Demographics
NPI:1346832979
Name:GURJIT RANDHAWA DENTAL, INC.
Entity Type:Organization
Organization Name:GURJIT RANDHAWA DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:RANDHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,DMD
Authorized Official - Phone:510-220-0415
Mailing Address - Street 1:2643 APPIAN WAY STE B
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2253
Mailing Address - Country:US
Mailing Address - Phone:510-758-0900
Mailing Address - Fax:
Practice Address - Street 1:2643 APPIAN WAY STE B
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2253
Practice Address - Country:US
Practice Address - Phone:510-758-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental