Provider Demographics
NPI:1598803868
Name:VAUGHAN, MITCHELL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:D
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1350 SPRING ST NW STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2870
Mailing Address - Country:US
Mailing Address - Phone:770-692-1000
Mailing Address - Fax:570-522-7072
Practice Address - Street 1:1150 LAKE HEARN DR STE 170
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1568
Practice Address - Country:US
Practice Address - Phone:770-692-1000
Practice Address - Fax:570-522-7072
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0129051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry