Provider Demographics
NPI:1255542726
Name:RANDHAWA, ANEET (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:ANEET
Middle Name:
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38323 BLACOW RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7115
Mailing Address - Country:US
Mailing Address - Phone:510-797-7620
Mailing Address - Fax:
Practice Address - Street 1:4138 DYER ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3975
Practice Address - Country:US
Practice Address - Phone:510-471-1255
Practice Address - Fax:510-471-9689
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49198122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice