Provider Demographics
NPI:1831768605
Name:VARGAS, RICARDO LUIS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:LUIS
Last Name:VARGAS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3171 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2804
Mailing Address - Country:US
Mailing Address - Phone:209-605-1044
Mailing Address - Fax:
Practice Address - Street 1:2991 TREAT BLVD STE F
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3604
Practice Address - Country:US
Practice Address - Phone:925-689-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics