Provider Demographics
NPI:1831403468
Name:GODOY, ANA VARGAS (DDS)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:VARGAS
Last Name:GODOY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:939 W CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2729
Mailing Address - Country:US
Mailing Address - Phone:408-509-5966
Mailing Address - Fax:
Practice Address - Street 1:14755 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8025
Practice Address - Country:US
Practice Address - Phone:909-349-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595891223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice