Provider Demographics
NPI:1619072261
Name:FOUR SEASONS DENTAL PA
Entity Type:Organization
Organization Name:FOUR SEASONS DENTAL PA
Other - Org Name:SASKIA C VAUGHAN DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/PRESIDENT/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SASKIA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-328-1131
Mailing Address - Street 1:501 E HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-5415
Mailing Address - Country:US
Mailing Address - Phone:940-328-1131
Mailing Address - Fax:940-328-1131
Practice Address - Street 1:510 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067
Practice Address - Country:US
Practice Address - Phone:940-328-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16103OtherLICENSE (TSBDE)