Provider Demographics
NPI:1053457317
Name:VAUGHAN, ROBERT D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 BIRKDALE CMNS PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6181
Mailing Address - Country:US
Mailing Address - Phone:704-655-8008
Mailing Address - Fax:704-655-8007
Practice Address - Street 1:16600 BIRKDALE CMNS PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6181
Practice Address - Country:US
Practice Address - Phone:704-655-8008
Practice Address - Fax:704-655-8007
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice