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General NPI Number Information
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NPI Number | 1508033291
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Entity Type | Organization
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Legal Business Name | A MELISSA VARGAS DMD, LTD
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 2222 W DIVISION ST SUITE 130
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City | CHICAGO
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State | IL
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Zip | 60622-2717
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Country | US
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Telephone | 773-772-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 3541 N LOWELL AVE
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City | CHICAGO
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State | IL
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Zip | 60641-3835
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Country | US
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Telephone | 773-758-2010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. A MELISSA LOPEZ
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Credential | DMD
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Telephone | 773-758-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019025964
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License Number State | IL
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