Provider Demographics
NPI:1962840199
Name:VARGAS, ALEJANDRO (DDS)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:VARGAS
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:N47W22244 WOODLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2723
Mailing Address - Country:US
Mailing Address - Phone:561-856-2518
Mailing Address - Fax:
Practice Address - Street 1:2700 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2455
Practice Address - Country:US
Practice Address - Phone:414-645-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7095-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist