Provider Demographics
NPI:1922185727
Name:JOHNSON, VAUGHN ANDREW (DDS, MS)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:ANDREW
Last Name:JOHNSON
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 1:801 FLORIDA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4780
Mailing Address - Country:US
Mailing Address - Phone:970-247-3330
Mailing Address - Fax:
Practice Address - Street 1:801 FLORIDA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4780
Practice Address - Country:US
Practice Address - Phone:970-247-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics