Provider Demographics
NPI:1396835039
Name:VARGAS, RODOLFO (DD,S)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:DD,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 DIXIELAND RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3351
Mailing Address - Country:US
Mailing Address - Phone:956-428-5322
Mailing Address - Fax:956-428-7986
Practice Address - Street 1:1214 DIXIELAND RD
Practice Address - Street 2:SUITE #4
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3351
Practice Address - Country:US
Practice Address - Phone:956-428-5322
Practice Address - Fax:956-428-7986
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1743247-01Medicaid