Provider Demographics
NPI:1215301916
Name:VARGAS, CHRISTIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 SW OAK WOOD LN
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8424
Mailing Address - Country:US
Mailing Address - Phone:816-719-9628
Mailing Address - Fax:
Practice Address - Street 1:811 S BUSINESS HIGHWAY 13 STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1572
Practice Address - Country:US
Practice Address - Phone:660-259-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMONAVD3300007171M00000X
MO20200237181223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator