Provider Demographics
NPI:1407274863
Name:VARGAS, AUDREY V (DDS)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:V
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3231
Mailing Address - Country:US
Mailing Address - Phone:714-670-0919
Mailing Address - Fax:714-670-0870
Practice Address - Street 1:6875 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3231
Practice Address - Country:US
Practice Address - Phone:714-670-0919
Practice Address - Fax:714-670-0870
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist