Provider Demographics
NPI:1386250215
Name:DR. LUIS G. VARGAS A DENTAL CORPORATION
Entity type:Organization
Organization Name:DR. LUIS G. VARGAS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-885-6262
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-0005
Mailing Address - Country:US
Mailing Address - Phone:909-885-6262
Mailing Address - Fax:909-752-3574
Practice Address - Street 1:965 S E ST STE N
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1940
Practice Address - Country:US
Practice Address - Phone:909-885-6262
Practice Address - Fax:909-752-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental