Healthcare Provider Details

I. General information

NPI: 1518703123
Provider Name (Legal Business Name): IYAMILET VARGAS ALVAREZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BLACK FOREST DR # 1
FAYETTEVILLE AR
72704-6551
US

IV. Provider business mailing address

3539 W EARNHARDT DR
FAYETTEVILLE AR
72704-6091
US

V. Phone/Fax

Practice location:
  • Phone: 479-888-5119
  • Fax:
Mailing address:
  • Phone: 305-896-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4772
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4772
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4772
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4772
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4772
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: