Provider Demographics
NPI:1275693541
Name:VARGAS, LUIS GILBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GILBERTO
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 1:965 S E ST STE N
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-1940
Mailing Address - Country:US
Mailing Address - Phone:909-885-6262
Mailing Address - Fax:909-383-8260
Practice Address - Street 1:965 S E ST STE N
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1940
Practice Address - Country:US
Practice Address - Phone:909-885-6262
Practice Address - Fax:909-383-8260
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice