Provider Demographics
NPI:1376603100
Name:LEE, VAUGHN ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:ANTHONY
Last Name:LEE
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 1:373 9TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6514
Mailing Address - Country:US
Mailing Address - Phone:510-834-4640
Mailing Address - Fax:510-834-8328
Practice Address - Street 1:373 9TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6514
Practice Address - Country:US
Practice Address - Phone:510-834-4640
Practice Address - Fax:510-834-8328
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB24471-01Medicaid