Provider Demographics
NPI:1689681322
Name:VAUGHAN, ROBIN TERESA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:TERESA
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9091 ALANADA DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8453
Mailing Address - Country:US
Mailing Address - Phone:616-891-8931
Mailing Address - Fax:616-891-9803
Practice Address - Street 1:9041 N RODGERS CT SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7660
Practice Address - Country:US
Practice Address - Phone:616-891-8931
Practice Address - Fax:616-891-9803
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010145421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538100482OtherNPI # FOR GLEN VALLEY D.
MI846910OtherUNITED CONCORDIA #
MID801041OtherBCBS OF MI ID #
MI4836800Medicaid