Provider Demographics
NPI:1720812191
Name:JESSICA VARGAS DDS PLLC
Entity type:Organization
Organization Name:JESSICA VARGAS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-518-0455
Mailing Address - Street 1:360 W HUBBARD ST APT 2404
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5753
Mailing Address - Country:US
Mailing Address - Phone:818-518-0455
Mailing Address - Fax:
Practice Address - Street 1:714 W MAXWELL ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5017
Practice Address - Country:US
Practice Address - Phone:312-455-8803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty