Provider Demographics
NPI:1356460042
Name:VAUGHAN, JANET L (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2601
Mailing Address - Country:US
Mailing Address - Phone:361-992-8161
Mailing Address - Fax:361-992-9075
Practice Address - Street 1:4461 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2601
Practice Address - Country:US
Practice Address - Phone:361-992-8161
Practice Address - Fax:361-992-9075
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10019OtherSTATE DENTAL LICENSE