Provider Demographics
NPI:1740315399
Name:VARGAS, ENRIQUE G (DMD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:G
Last Name:VARGAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ENRIQUE
Other - Middle Name:G
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2841 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6649
Mailing Address - Country:US
Mailing Address - Phone:352-373-1000
Mailing Address - Fax:373-271-5255
Practice Address - Street 1:2841 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6649
Practice Address - Country:US
Practice Address - Phone:352-373-1000
Practice Address - Fax:373-271-5255
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics