Provider Demographics
NPI:1134840382
Name:GARG, VIBHUTI (DMD)
Entity type:Individual
Prefix:
First Name:VIBHUTI
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4826
Mailing Address - Country:US
Mailing Address - Phone:612-447-9053
Mailing Address - Fax:
Practice Address - Street 1:5149 NORMANDY BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4861
Practice Address - Country:US
Practice Address - Phone:904-781-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27511122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist