Provider Demographics
NPI:1790841633
Name:RANDHAWA, ANEEL KAUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANEEL
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50481 KOSS DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6320
Mailing Address - Country:US
Mailing Address - Phone:586-226-0638
Mailing Address - Fax:
Practice Address - Street 1:30205 SCHOENHERR RD
Practice Address - Street 2:SUITEA
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6800
Practice Address - Country:US
Practice Address - Phone:586-558-8200
Practice Address - Fax:586-558-8300
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist