Provider Demographics
NPI:1710057088
Name:VARGO, JOSEPH KENT (DMD MS PC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KENT
Last Name:VARGO
Suffix:
Gender:M
Credentials:DMD MS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 EAST SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161
Mailing Address - Country:US
Mailing Address - Phone:706-506-4209
Mailing Address - Fax:
Practice Address - Street 1:419 EAST SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161
Practice Address - Country:US
Practice Address - Phone:706-290-0011
Practice Address - Fax:706-238-9726
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics