Provider Demographics
NPI:1962648303
Name:JOHN, VARGHESE P (D M D)
Entity Type:Individual
Prefix:DR
First Name:VARGHESE
Middle Name:P
Last Name:JOHN
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 HIGHWAY 90A
Mailing Address - Street 2:STE 160-D
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3196
Mailing Address - Country:US
Mailing Address - Phone:281-494-5600
Mailing Address - Fax:281-494-5588
Practice Address - Street 1:9920 HIGHWAY 90A
Practice Address - Street 2:STE 160-D
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3196
Practice Address - Country:US
Practice Address - Phone:281-494-5600
Practice Address - Fax:281-494-5588
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist