MEDICARE: DIRECT DENTAL SOLUTIONS NORTH PLLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1710502554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT DENTAL SOLUTIONS NORTH PLLC

Provider Business Mailing Address
First Line	:	18331 PINES BLVD # 206
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1421
Country	:	US
Telephone Number	:	888-417-3211
Fax Number	:	888-417-3216

Provider Business Practice Location Address
First Line	:	18331 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1421
Country	:	US
Telephone Number	:	954-937-1840
Fax Number	:	888-417-3216

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ELLEN F VARGAS
Credential	:	DMD
Telephone Number	:	561-308-5854

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	02/21/2022

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