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General NPI Number Information
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NPI Number | 1326463126
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Entity Type | Individual
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Provider Name | EDEGAR VERGARA DMD
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Gender | Male
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 2340 MCKEE RD STE 3
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City | SAN JOSE
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State | CA
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Zip | 95116-1615
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Country | US
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Telephone | 669-284-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 4621 CAPITAN DR
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City | FREMONT
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State | CA
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Zip | 94536-5447
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Country | US
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Telephone | 510-585-7977
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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 | 30-024422
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63272
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License Number State | CA
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