Provider Demographics
NPI:1073638326
Name:VARGAS, CLARA PATRICIA (DMD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:PATRICIA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1826
Mailing Address - Country:US
Mailing Address - Phone:781-251-0550
Mailing Address - Fax:781-251-0550
Practice Address - Street 1:263 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1826
Practice Address - Country:US
Practice Address - Phone:781-251-0550
Practice Address - Fax:781-251-0550
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice