Provider Demographics
NPI:1134290927
Name:EDUARDO VARGAS DDS MS PC
Entity Type:Organization
Organization Name:EDUARDO VARGAS DDS MS PC
Other - Org Name:BOWIE PROSTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:301-390-9772
Mailing Address - Street 1:2905 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:301-390-9772
Mailing Address - Fax:301-390-3114
Practice Address - Street 1:2905 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-390-9772
Practice Address - Fax:301-390-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty