1790841633 NPI number — DR. ANEEL KAUR RANDHAWA D.D.S.

Table of content: DR. ANEEL KAUR RANDHAWA D.D.S. (NPI 1790841633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790841633 NPI number — DR. ANEEL KAUR RANDHAWA D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDHAWA
Provider First Name:
ANEEL
Provider Middle Name:
KAUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790841633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50481 KOSS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACOMB
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48044-6320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-226-0638
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30205 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
SUITEA
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48088-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-558-8200
Provider Business Practice Location Address Fax Number:
586-558-8300
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901019199 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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