Healthcare Provider Details

I. General information

NPI: 1396596177
Provider Name (Legal Business Name): JEMIMA SARAH VARUGHESE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FM 1488 RD STE 90
CONROE TX
77384-3818
US

IV. Provider business mailing address

14327 TEMPLAR LN
SUGAR LAND TX
77498-1437
US

V. Phone/Fax

Practice location:
  • Phone: 936-271-5440
  • Fax:
Mailing address:
  • Phone: 832-715-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number42373
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: