Provider Demographics
NPI:1235596149
Name:CALL, VAUGHN (DMD)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:
Last Name:CALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15407 S CAMINO AGUA AZUL
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8854
Mailing Address - Country:US
Mailing Address - Phone:623-340-1015
Mailing Address - Fax:
Practice Address - Street 1:2421 CABEZON BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1515
Practice Address - Country:US
Practice Address - Phone:505-884-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD44471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice