MEDICARE: DR. WILLIAM CHARLES VARGO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2950	UT

General Provider Information

NPI Number	:	1275734451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM CHARLES VARGO D.D.S.

Provider Business Mailing Address
First Line	:	7138 HIGHLAND DR SUITE #219
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3757
Country	:	US
Telephone Number	:	801-943-9090
Fax Number	:	801-943-2210

Provider Business Practice Location Address
First Line	:	7138 HIGHLAND DR STE 219
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3788
Country	:	US
Telephone Number	:	801-943-9090
Fax Number	:	801-943-2210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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