Provider Demographics
NPI:1790965598
Name:RANDHAWA, GULBADAN
Entity Type:Individual
Prefix:DR
First Name:GULBADAN
Middle Name:
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 BLACKSMITH ST.
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N6H5R5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NONE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:ONTARIO
Practice Address - Zip Code:000000
Practice Address - Country:CA
Practice Address - Phone:519-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist