Provider Demographics
NPI:1841405149
Name:BAWA, RAJDEEP S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJDEEP
Middle Name:S
Last Name:BAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:BAWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:39 S LIVERMORE AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-3119
Mailing Address - Country:US
Mailing Address - Phone:925-373-7311
Mailing Address - Fax:925-373-7310
Practice Address - Street 1:39 S LIVERMORE AVE STE 217
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-3119
Practice Address - Country:US
Practice Address - Phone:925-373-7311
Practice Address - Fax:925-373-7310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice