MEDICARE: DR. SOFIA VAQAR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	31471	TX

General Provider Information

NPI Number	:	1396113320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOFIA VAQAR DMD

Provider Business Mailing Address
First Line	:	3415 W WALNUT ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-7117
Country	:	US
Telephone Number	:	972-265-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 W WALNUT ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-7117
Country	:	US
Telephone Number	:	972-265-7888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	10/28/2016

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