Provider Demographics
NPI:1548380215
Name:NIKKI WARGO DDS INC
Entity Type:Organization
Organization Name:NIKKI WARGO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WARGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-756-6214
Mailing Address - Street 1:1452 E 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8905
Mailing Address - Country:US
Mailing Address - Phone:219-756-6214
Mailing Address - Fax:219-756-6214
Practice Address - Street 1:1452 E 85TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8905
Practice Address - Country:US
Practice Address - Phone:219-756-6214
Practice Address - Fax:219-756-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010645A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200490450Medicaid