Provider Demographics
NPI:1285809996
Name:AGUILERA, RANDOLPH EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:EDWARD
Last Name:AGUILERA
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 1:33 CREEK RD
Mailing Address - Street 2:#C-350
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4791
Mailing Address - Country:US
Mailing Address - Phone:949-936-0022
Mailing Address - Fax:949-936-0018
Practice Address - Street 1:33 CREEK RD
Practice Address - Street 2:#C-350
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4791
Practice Address - Country:US
Practice Address - Phone:949-936-0022
Practice Address - Fax:949-936-0018
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31893122300000X
TX20862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist