Provider Demographics
NPI:1326562752
Name:VARGAS, FERNANDO LOPEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:LOPEZ
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 1:2121 SUNSET BLVD APT 2434
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4797
Mailing Address - Country:US
Mailing Address - Phone:209-380-7326
Mailing Address - Fax:
Practice Address - Street 1:4000 FOOTHILLS BLVD STE 126
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7251
Practice Address - Country:US
Practice Address - Phone:916-771-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice