Provider Demographics
NPI:1053466250
Name:VAUGHAN, NADINE LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:LYNN
Last Name:VAUGHAN
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 1:2018 NAAMANS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2659
Mailing Address - Country:US
Mailing Address - Phone:302-475-3743
Mailing Address - Fax:302-475-7110
Practice Address - Street 1:2018 NAAMANS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-2659
Practice Address - Country:US
Practice Address - Phone:302-475-3743
Practice Address - Fax:302-475-7110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100010781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000909508Medicaid