Provider Demographics
NPI:1114595840
Name:VARGAS, DANIELA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
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 1:3689 CLEARBROOKE WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7388
Mailing Address - Country:US
Mailing Address - Phone:678-558-5305
Mailing Address - Fax:
Practice Address - Street 1:5805 STATE BRIDGE RD STE L
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-6427
Practice Address - Country:US
Practice Address - Phone:678-474-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist