Basic Information
| Provider Information | |||||||||
| NPI: | 1114048758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGHESE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9090 SKILLMAN ST | ||||||||
| Address2: | SUITE 200C | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752438259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143425757 | ||||||||
| FaxNumber: | 2143404868 | ||||||||
| Practice Location | |||||||||
| Address1: | 6780 ABRAMS RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752317180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143404867 | ||||||||
| FaxNumber: | 2143413296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 17873 | TX | X | Dental Providers | Dentist | 1223G0001X | 17873 | TX | X | Dental Providers | Dentist | General Practice |
No ID Information.