Provider Demographics
NPI:1396104097
Name:GEORGEANN C. VARGAS DDS, LTD
Entity type:Organization
Organization Name:GEORGEANN C. VARGAS DDS, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGEANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-646-2161
Mailing Address - Street 1:601 STATE ROAD 35
Mailing Address - Street 2:PO BOX 459
Mailing Address - City:CENTURIA
Mailing Address - State:WI
Mailing Address - Zip Code:54824-9014
Mailing Address - Country:US
Mailing Address - Phone:715-646-2161
Mailing Address - Fax:715-646-2023
Practice Address - Street 1:601 STATE ROAD 35
Practice Address - Street 2:
Practice Address - City:CENTURIA
Practice Address - State:WI
Practice Address - Zip Code:54824-9014
Practice Address - Country:US
Practice Address - Phone:715-646-2161
Practice Address - Fax:715-646-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001112261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental