Healthcare Provider Details

I. General information

NPI: 1184576340
Provider Name (Legal Business Name): EFRAIN ALVARADO VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 E US ROUTE 36
DECATUR IL
62521-5085
US

IV. Provider business mailing address

213 PURYEAR ST
INDIANAPOLIS IN
46202-4463
US

V. Phone/Fax

Practice location:
  • Phone: 217-423-2400
  • Fax:
Mailing address:
  • Phone: 317-845-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036863
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: