Provider Demographics
NPI:1003946815
Name:VARGAS, FELIPE SANTIAGO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:SANTIAGO
Last Name:VARGAS
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 1:7704 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1852
Mailing Address - Country:US
Mailing Address - Phone:718-296-0076
Mailing Address - Fax:718-296-9069
Practice Address - Street 1:7704 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1852
Practice Address - Country:US
Practice Address - Phone:718-296-0076
Practice Address - Fax:718-296-9069
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY970818OtherUNITED CONCORDIA
NY01461985Medicaid