Provider Demographics
NPI:1124454186
Name:ARGUELLO DENTISTRY LLC
Entity type:Organization
Organization Name:ARGUELLO DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIGARNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARGUELLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-532-1274
Mailing Address - Street 1:100 N STATE ROAD 7
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4520
Mailing Address - Country:US
Mailing Address - Phone:954-532-1274
Mailing Address - Fax:954-532-1797
Practice Address - Street 1:100 N STATE ROAD 7
Practice Address - Street 2:SUITE 300
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4520
Practice Address - Country:US
Practice Address - Phone:954-532-1274
Practice Address - Fax:954-532-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004166800Medicaid