Provider Demographics
NPI:1285007633
Name:KEITH E. VAUGHAN, PLLC
Entity Type:Organization
Organization Name:KEITH E. VAUGHAN, PLLC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-898-3366
Mailing Address - Street 1:6521 GEORGE WASHINGTON MEM HWY
Mailing Address - Street 2:P.O. BOX 1207
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2169
Mailing Address - Country:US
Mailing Address - Phone:757-898-3366
Mailing Address - Fax:757-898-7390
Practice Address - Street 1:6521 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2169
Practice Address - Country:US
Practice Address - Phone:757-898-3366
Practice Address - Fax:757-898-7390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty