Provider Demographics
NPI:1922120344
Name:AGNEW, RANDY L (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
Last Name:AGNEW
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 1:3110 CHINO AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1211
Mailing Address - Country:US
Mailing Address - Phone:909-364-8282
Mailing Address - Fax:
Practice Address - Street 1:3110 CHINO AVE STE 260
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1211
Practice Address - Country:US
Practice Address - Phone:909-364-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist