Provider Demographics
NPI:1891041349
Name:RANDHAWA, MANPREET KAUR (DDS)
Entity type:Individual
Prefix:
First Name:MANPREET
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 W BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0795
Mailing Address - Country:US
Mailing Address - Phone:800-492-4227
Mailing Address - Fax:559-646-3652
Practice Address - Street 1:300 WESTGATE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-9693
Practice Address - Country:US
Practice Address - Phone:800-492-4227
Practice Address - Fax:831-918-0928
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist