Healthcare Provider Details

I. General information

NPI: 1033745849
Provider Name (Legal Business Name): JENNIFER VARGAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10117 CLEARY BLVD
PLANTATION FL
33324-1066
US

IV. Provider business mailing address

2124 NW 171ST TER
PEMBROKE PINES FL
33028-2054
US

V. Phone/Fax

Practice location:
  • Phone: 954-916-9060
  • Fax:
Mailing address:
  • Phone: 954-696-8308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN27478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: