Provider Demographics
NPI:1306594312
Name:GURJIT S RANDHWA DDS, INC.
Entity type:Organization
Organization Name:GURJIT S RANDHWA DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,DMD
Authorized Official - Phone:510-220-0415
Mailing Address - Street 1:2229 SANTA CLARA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4409
Mailing Address - Country:US
Mailing Address - Phone:510-521-3300
Mailing Address - Fax:510-521-3301
Practice Address - Street 1:2229 SANTA CLARA AVE STE E
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4409
Practice Address - Country:US
Practice Address - Phone:510-521-3300
Practice Address - Fax:510-521-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental