Healthcare Provider Details

I. General information

NPI: 1619127743
Provider Name (Legal Business Name): JOSEPH VARGAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 CROFTON CTR STE 7
CROFTON MD
21114-1303
US

IV. Provider business mailing address

28095 THREE NOTCH RD #1A
MECHANICSVILLE MD
20659-3373
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-2424
  • Fax:
Mailing address:
  • Phone: 301-884-8133
  • Fax: 301-884-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14379
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: