Provider Demographics
NPI:1104495209
Name:CONROE ADVANCED DENTISTRY, PLLC
Entity type:Organization
Organization Name:CONROE ADVANCED DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VARGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-242-4337
Mailing Address - Street 1:6818 FAWNCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-3107
Mailing Address - Country:US
Mailing Address - Phone:832-242-4337
Mailing Address - Fax:
Practice Address - Street 1:2040 N LOOP 336 W STE 207
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3580
Practice Address - Country:US
Practice Address - Phone:936-759-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental