Provider Demographics
NPI:1114972056
Name:DEVAUGHN, RICHARD LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LYNN
Last Name:DEVAUGHN
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 1:702 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5930
Mailing Address - Country:US
Mailing Address - Phone:580-233-2044
Mailing Address - Fax:580-233-1533
Practice Address - Street 1:702 E PARK ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5930
Practice Address - Country:US
Practice Address - Phone:580-233-2044
Practice Address - Fax:580-233-1533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice