Provider Demographics
NPI:1285127597
Name:VARGAS, STEPHANIE JASMINE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JASMINE
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 1:15832 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1513
Mailing Address - Country:US
Mailing Address - Phone:631-332-3134
Mailing Address - Fax:
Practice Address - Street 1:789 S VICTORIA AVE STE 204
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9077
Practice Address - Country:US
Practice Address - Phone:805-644-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1057191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program