Provider Demographics
NPI:1659505196
Name:VAUGHN, PARIS DEVON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARIS
Middle Name:DEVON
Last Name:VAUGHN
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 1:4565 DAISY REID AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5672
Mailing Address - Country:US
Mailing Address - Phone:202-641-4201
Mailing Address - Fax:571-285-2579
Practice Address - Street 1:4565 DAISY REID AVE STE 210
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5672
Practice Address - Country:US
Practice Address - Phone:202-641-4201
Practice Address - Fax:571-285-2579
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411660122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist