Provider Demographics
NPI:1497799340
Name:VARGAS, ROLAND PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:PAUL
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 1:6750 TEZEL RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4183
Mailing Address - Country:US
Mailing Address - Phone:210-523-2345
Mailing Address - Fax:210-680-1600
Practice Address - Street 1:6750 TEZEL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-4183
Practice Address - Country:US
Practice Address - Phone:210-523-2345
Practice Address - Fax:210-680-1600
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135056306Medicaid