Provider Demographics
NPI:1083942940
Name:OLIVER, VAUGHN MILTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:MILTON
Last Name:OLIVER
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 1:1953 E Y X RANCH RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9407
Mailing Address - Country:US
Mailing Address - Phone:928-774-0586
Mailing Address - Fax:
Practice Address - Street 1:1953 E Y X RANCH RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9407
Practice Address - Country:US
Practice Address - Phone:928-774-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 1723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist