Provider Demographics
NPI:1396167896
Name:CHINO HILLS DENTISTRY
Entity type:Organization
Organization Name:CHINO HILLS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:AGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-364-8282
Mailing Address - Street 1:3110 CHINO AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709
Mailing Address - Country:US
Mailing Address - Phone:909-364-8282
Mailing Address - Fax:909-364-8330
Practice Address - Street 1:3110 CHINO AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709
Practice Address - Country:US
Practice Address - Phone:909-364-8282
Practice Address - Fax:909-364-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty