Provider Demographics
NPI:1831318047
Name:VERGARA, VICTOR (DMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:VERGARA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 AIRPORT PULLING RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2407
Mailing Address - Country:US
Mailing Address - Phone:239-263-0912
Mailing Address - Fax:239-263-0925
Practice Address - Street 1:5034 AIRPORT PULLING RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-2407
Practice Address - Country:US
Practice Address - Phone:239-263-0912
Practice Address - Fax:239-263-0925
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice