Provider Demographics
NPI:1609968874
Name:VARGAS, LIDA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIDA
Middle Name:MARIA
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 1:208 WHITMOOR TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1521
Mailing Address - Country:US
Mailing Address - Phone:301-681-7169
Mailing Address - Fax:
Practice Address - Street 1:3911 OLD LEE HWY
Practice Address - Street 2:SUITE 42 C
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2434
Practice Address - Country:US
Practice Address - Phone:703-385-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA411057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist