Provider Demographics
NPI:1639293822
Name:STEWART, VAUGHN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:G
Last Name:STEWART
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 1:2500 E IMPERIAL HWY
Mailing Address - Street 2:SUITE #166
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6122
Mailing Address - Country:US
Mailing Address - Phone:714-529-5920
Mailing Address - Fax:714-529-4753
Practice Address - Street 1:2500 E IMPERIAL HWY
Practice Address - Street 2:SUITE #166
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6122
Practice Address - Country:US
Practice Address - Phone:714-529-5920
Practice Address - Fax:714-529-4753
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice