Provider Demographics
NPI:1134246663
Name:RANDHAWA, HAROON (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROON
Middle Name:
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 WILLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5809
Mailing Address - Country:US
Mailing Address - Phone:217-801-2556
Mailing Address - Fax:
Practice Address - Street 1:2091 N COLLINS BLVD # 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2636
Practice Address - Country:US
Practice Address - Phone:972-644-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026029122300000X
TX35016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist