Provider Demographics
NPI:1477652857
Name:VAUGHT, DANIEL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:VAUGHT
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 1:17250 N 43RD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4033
Mailing Address - Country:US
Mailing Address - Phone:602-938-7751
Mailing Address - Fax:
Practice Address - Street 1:17250 N 43RD AVE STE 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4033
Practice Address - Country:US
Practice Address - Phone:602-938-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0084431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036199Medicaid
WA0141078OtherLABOR & INDUSTRIES