Provider Demographics
NPI:1528000841
Name:VERGARA, SANDRA (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:VERGARA
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5007
Mailing Address - Country:US
Mailing Address - Phone:940-264-6000
Mailing Address - Fax:
Practice Address - Street 1:1004 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5031
Practice Address - Country:US
Practice Address - Phone:940-264-6000
Practice Address - Fax:940-687-7104
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery