Healthcare Provider Details

I. General information

NPI: 1215301916
Provider Name (Legal Business Name): CHRISTIAN VARGAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S BUSINESS HIGHWAY 13 STE A
LEXINGTON MO
64067-1572
US

IV. Provider business mailing address

431 SW OAK WOOD LN
GRAIN VALLEY MO
64029-8424
US

V. Phone/Fax

Practice location:
  • Phone: 660-259-2440
  • Fax:
Mailing address:
  • Phone: 816-719-9628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMONAVD3300007
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2020023718
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: