Healthcare Provider Details

I. General information

NPI: 1295654242
Provider Name (Legal Business Name): DAVID VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 LAKE NONA VILLAGE PL
ORLANDO FL
32827-7319
US

IV. Provider business mailing address

10117 SWEETLEAF ST
ORLANDO FL
32827-6864
US

V. Phone/Fax

Practice location:
  • Phone: 314-629-0836
  • Fax:
Mailing address:
  • Phone: 314-629-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: