Provider Demographics
NPI:1114606811
Name:VIRGINIA DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:VIRGINIA DENTAL GROUP PLLC
Other - Org Name:LIDA M VARGAS DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-385-3800
Mailing Address - Street 1:3911 BLENHEIM BLVD STE 42C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2434
Mailing Address - Country:US
Mailing Address - Phone:703-385-3800
Mailing Address - Fax:703-890-0084
Practice Address - Street 1:3911 BLENHEIM BLVD STE 42C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2434
Practice Address - Country:US
Practice Address - Phone:703-385-3800
Practice Address - Fax:703-890-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty