Provider Demographics
NPI:1275668121
Name:VAUGHAN, RONALD OAKLEY (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:OAKLEY
Last Name:VAUGHAN
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:PO BOX 797
Mailing Address - Street 2:158 N. WASHINGTON AVE
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-0797
Mailing Address - Country:US
Mailing Address - Phone:540-980-4695
Mailing Address - Fax:
Practice Address - Street 1:158 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5020
Practice Address - Country:US
Practice Address - Phone:540-980-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010041741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice