MEDICARE: RANDA NASR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1790529287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDA NASR DDS

Provider Business Mailing Address
First Line	:	12854 10TH ST STE D
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4255
Country	:	US
Telephone Number	:	909-628-5540
Fax Number	:	909-627-6533

Provider Business Practice Location Address
First Line	:	12854 10TH ST STE D
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4255
Country	:	US
Telephone Number	:	909-628-5540
Fax Number	:	909-627-6533

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. RANDA NASR
Credential	:	DDS
Telephone Number	:	909-831-2072

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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