Provider Demographics
NPI:1922091289
Name:VAUGHAN, WILLIAM EARLE SR (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EARLE
Last Name:VAUGHAN
Suffix:SR
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 1:1818 NEWTON STREET N.W.
Mailing Address - Street 2:STODDARD BAPTIST NURSING HOME
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-328-7400
Mailing Address - Fax:202-328-0421
Practice Address - Street 1:1818 NEWTON STREET N.W.
Practice Address - Street 2:STODDARD BAPTIST NURSING HOME
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-328-7400
Practice Address - Fax:202-328-0421
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2019-10-22
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
DCDEN3096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist