Provider Demographics
NPI:1376550426
Name:KLEMENT JUNGMAN & VARGA DDS PA
Entity Type:Organization
Organization Name:KLEMENT JUNGMAN & VARGA DDS PA
Other - Org Name:SUNDENT CARE LLC AND ZAMIKOFF KLEMENT JUNGMAN DDS PA
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-792-2766
Mailing Address - Street 1:2103 59TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-792-2766
Mailing Address - Fax:941-795-7531
Practice Address - Street 1:2103 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-2766
Practice Address - Fax:941-795-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN6193122300000X
FLDN9109122300000X
FLDN11099122300000X
FLDN153281223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593645550OtherTAX ID
FL=========OtherTAX ID