Provider Demographics
NPI:1922626019
Name:BAGAY, RANDY (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:BAGAY
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 1:205 VILLAGE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-4544
Mailing Address - Country:US
Mailing Address - Phone:904-201-1435
Mailing Address - Fax:
Practice Address - Street 1:205 VILLAGE COMMONS DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-4544
Practice Address - Country:US
Practice Address - Phone:904-201-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL288091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice