Organization
MAITE VARGAS DENTAL CORPORATION
Active
Other names
DENTIST ON WHEELS CA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAITE VARGAS DDS (CEO)
(786) 554-9845
Entity
Organization
Contact information
Practice address
500 S BROADWAY, SUITE 246, SANTA MARIA, CA 93454-5148
(855) 369-8585
Mailing address
500 S BROADWAY, SUITE 246, SANTA MARIA, CA 93454-5148
(855) 369-8585
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
54219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54219
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
09/12/2013
Last updated
09/12/2013
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