Provider Demographics
NPI:1063025336
Name:VAUGHAN FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:VAUGHAN FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:931-427-8581
Mailing Address - Street 1:27001 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449
Mailing Address - Country:US
Mailing Address - Phone:931-427-8581
Mailing Address - Fax:931-427-8588
Practice Address - Street 1:27001 MAIN ST.
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449
Practice Address - Country:US
Practice Address - Phone:931-427-8581
Practice Address - Fax:931-427-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty