Healthcare Provider Details

I. General information

NPI: 1841402971
Provider Name (Legal Business Name): JOHN WESLEY VARGO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OKATIE CENTER BLVD S STE 103
OKATIE SC
29909-7530
US

IV. Provider business mailing address

309 GREENWOOD DR
HILTON HEAD ISLAND SC
29928-4223
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-9551
  • Fax:
Mailing address:
  • Phone: 843-363-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: