Provider Demographics
NPI:1063516060
Name:VARGAS, KAAREN GISELLE (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:KAAREN
Middle Name:GISELLE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 LININGER LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-2316
Mailing Address - Country:US
Mailing Address - Phone:319-665-2573
Mailing Address - Fax:866-205-1876
Practice Address - Street 1:1730 LININGER LN
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-2322
Practice Address - Country:US
Practice Address - Phone:319-665-2573
Practice Address - Fax:866-205-1876
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1184358Medicaid