Provider Demographics
NPI:1780818096
Name:VARGAS, MARISOL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
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 1:1005 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5087
Mailing Address - Country:US
Mailing Address - Phone:214-941-0039
Mailing Address - Fax:214-941-0645
Practice Address - Street 1:1005 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5087
Practice Address - Country:US
Practice Address - Phone:214-941-0039
Practice Address - Fax:214-941-0645
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist