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General NPI Number Information
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NPI Number | 1184576340
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Entity Type | Individual
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Provider Name | EFRAIN ALVARADO VARGAS
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Gender | Male
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 1905 CONVENIENCE PL STE A
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City | CHAMPAIGN
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State | IL
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Zip | 61820-8927
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Country | US
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Telephone | 217-275-5813
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Fax |
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Provider Business Mailing Address
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Address Line | 213 PURYEAR ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-4463
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Country | US
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Telephone | 317-845-6466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.036863
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License Number State | IL
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