Healthcare Provider Details

I. General information

NPI: 1083082515
Provider Name (Legal Business Name): RICHARD J. VARGO DMD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1500 PARK AVE
SAINT LOUIS MO
63104-3024
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2500
  • Fax:
Mailing address:
  • Phone: 412-608-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2018015359
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2018015359
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: