Provider Demographics
NPI:1528085073
Name:VARGAS, SANDRA LUCIA (DMD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LUCIA
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 1:5805 STATE BRIDGE RD.
Mailing Address - Street 2:SUITE L
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:678-474-4917
Mailing Address - Fax:678-474-0244
Practice Address - Street 1:5805 STATE BRIDGE RD.
Practice Address - Street 2:SUITE L
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:678-474-4917
Practice Address - Fax:678-474-0244
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA117911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice