Provider Demographics
NPI:1851313811
Name:VERGARA, JAIME A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:VERGARA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 KIRBY DR STE 601
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3933
Mailing Address - Country:US
Mailing Address - Phone:713-521-1444
Mailing Address - Fax:
Practice Address - Street 1:3730 KIRBY DR STE 601
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3933
Practice Address - Country:US
Practice Address - Phone:713-521-1444
Practice Address - Fax:713-521-7347
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics