Healthcare Provider Details

I. General information

NPI: 1235847088
Provider Name (Legal Business Name): MARISOL VARGAS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N ZANG BLVD STE 150
DALLAS TX
75208-4123
US

IV. Provider business mailing address

1018 N ZANG BLVD STE 150
DALLAS TX
75208-4123
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-0039
  • Fax:
Mailing address:
  • Phone: 214-941-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN TUINEI
Title or Position: CREDENTIALING ASSISTANT
Credential:
Phone: 888-808-4513