Provider Demographics
NPI:1033412036
Name:VAUGHT, ROBERT A (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:VAUGHT
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1918
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-1918
Mailing Address - Country:US
Mailing Address - Phone:912-756-2309
Mailing Address - Fax:
Practice Address - Street 1:2701 US HIGHWAY 17
Practice Address - Street 2:SUITE 2B
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3799
Practice Address - Country:US
Practice Address - Phone:912-756-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA813625OtherUNITED CONCORDIA