Healthcare Provider Details

I. General information

NPI: 1891744009
Provider Name (Legal Business Name): JOSEPH WILLIAM VARGAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD #7500, BLDG 4070
FORT WAINWRIGHT AK
99703-5001
US

IV. Provider business mailing address

3002 RIVERVIEW DR
FAIRBANKS AK
99709-4735
US

V. Phone/Fax

Practice location:
  • Phone: 907-353-2917
  • Fax:
Mailing address:
  • Phone: 907-460-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6789
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: