Healthcare Provider Details

I. General information

NPI: 1831403468
Provider Name (Legal Business Name): ANA VARGAS GODOY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANA VARGAS DDS

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14755 FOOTHILL BLVD
FONTANA CA
92335-8025
US

IV. Provider business mailing address

939 W CUMBERLAND ST
UPLAND CA
91786-2729
US

V. Phone/Fax

Practice location:
  • Phone: 909-349-1360
  • Fax:
Mailing address:
  • Phone: 408-509-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59589
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: