Provider Demographics
NPI:1326583717
Name:FAMILY DENTAL CARE OF MILAN
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE OF MILAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-686-0105
Mailing Address - Street 1:2014 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-2750
Mailing Address - Country:US
Mailing Address - Phone:731-686-0105
Mailing Address - Fax:731-686-8361
Practice Address - Street 1:2014 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-2750
Practice Address - Country:US
Practice Address - Phone:731-686-0105
Practice Address - Fax:731-686-8361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty