Provider Demographics
NPI:1265021554
Name:VAUGHAN, DUSTIN L (MSOM, DIPL OM, AP)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:L
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MSOM, DIPL OM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 W MINNEOLA AVE UNIT 121262
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-7052
Mailing Address - Country:US
Mailing Address - Phone:352-901-4513
Mailing Address - Fax:352-404-7640
Practice Address - Street 1:835 7TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2190
Practice Address - Country:US
Practice Address - Phone:352-901-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty