Provider Demographics
NPI:1972348043
Name:VARGAS GROUP INC. DBA GUADALUPE DENTAL CLINIC
Entity type:Organization
Organization Name:VARGAS GROUP INC. DBA GUADALUPE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:CORVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-215-0143
Mailing Address - Street 1:4016 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2249
Mailing Address - Country:US
Mailing Address - Phone:415-819-6689
Mailing Address - Fax:510-215-0507
Practice Address - Street 1:4016 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2249
Practice Address - Country:US
Practice Address - Phone:415-819-6689
Practice Address - Fax:510-215-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental