Provider Demographics
NPI:1679512453
Name:NASR, RANDA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDA
Middle Name:R
Last Name:NASR
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 1:8824 E GARDEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1677
Mailing Address - Country:US
Mailing Address - Phone:909-831-2072
Mailing Address - Fax:714-634-1962
Practice Address - Street 1:12854 10TH ST STE D
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4298
Practice Address - Country:US
Practice Address - Phone:909-628-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice