Provider Demographics
NPI:1306918776
Name:VARGO, JAMES W (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:VARGO
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3474 JEFFERSON ST N #105
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901
Mailing Address - Country:US
Mailing Address - Phone:681-318-3364
Mailing Address - Fax:681-318-3365
Practice Address - Street 1:3474 JEFFERSON ST N #105
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901
Practice Address - Country:US
Practice Address - Phone:681-318-3364
Practice Address - Fax:681-318-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0133694000Medicaid