Provider Demographics
NPI:1750493896
Name:MCGRAW, VAUGHN A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:A
Last Name:MCGRAW
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 M 119
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8914
Mailing Address - Country:US
Mailing Address - Phone:231-347-2518
Mailing Address - Fax:231-347-8530
Practice Address - Street 1:2115 M 119
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8914
Practice Address - Country:US
Practice Address - Phone:231-347-2518
Practice Address - Fax:231-347-8530
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010101591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5246004OtherBCBS-MEDICAL
MID101590OtherBCBS OF MICHIGAN-DENTAL
MI2881039Medicaid
MI2881039Medicaid
MI5246004OtherBCBS-MEDICAL