Healthcare Provider Details

I. General information

NPI: 1932023355
Provider Name (Legal Business Name): CHRISTINA MARY VARGHESE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46984 RIVERWOODS DR
MACOMB MI
48044-5708
US

IV. Provider business mailing address

46984 RIVERWOODS DR
MACOMB MI
48044-5708
US

V. Phone/Fax

Practice location:
  • Phone: 586-488-9596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5315267911
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: