Provider Demographics
NPI:1285039479
Name:VARGAS, EDUARDO
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 SCIENCE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4420
Mailing Address - Country:US
Mailing Address - Phone:301-464-4672
Mailing Address - Fax:
Practice Address - Street 1:17000 SCIENCE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4420
Practice Address - Country:US
Practice Address - Phone:301-464-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106821223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics