Provider Demographics
NPI:1952671737
Name:VARGAS, CLEMENCIA MARIA (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:CLEMENCIA
Middle Name:MARIA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 SOLAR WALK
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3402
Mailing Address - Country:US
Mailing Address - Phone:410-706-2678
Mailing Address - Fax:410-706-3028
Practice Address - Street 1:650 W BALTIMORE ST
Practice Address - Street 2:ROOM 2217
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1510
Practice Address - Country:US
Practice Address - Phone:410-706-2678
Practice Address - Fax:410-760-3028
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD38122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist