Provider Demographics
NPI:1477663292
Name:VARGHESE P JOHN DMD PC
Entity Type:Organization
Organization Name:VARGHESE P JOHN DMD PC
Other - Org Name:ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VARGHESE
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-494-5600
Mailing Address - Street 1:9920 US HIGHWAY 90-A
Mailing Address - Street 2:STE 160D
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-494-5600
Mailing Address - Fax:281-494-5588
Practice Address - Street 1:9920 US HIGHWAY 90-A
Practice Address - Street 2:STE 160-D
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-494-5600
Practice Address - Fax:281-494-5588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VARGHESE P JOHN DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty