Provider Demographics
NPI:1992913362
Name:VARGAS, VANESSA N (DMD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:N
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 LATITUDE LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8124
Mailing Address - Country:US
Mailing Address - Phone:803-810-2211
Mailing Address - Fax:
Practice Address - Street 1:244 LATITUDE LN
Practice Address - Street 2:SUITE 103
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-8124
Practice Address - Country:US
Practice Address - Phone:803-810-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109091223G0001X
SC42731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice