Provider Demographics
NPI:1942360847
Name:KEARBEY, VAUGHN EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:EVAN
Last Name:KEARBEY
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 1:455 ORO DAM BLVD E
Mailing Address - Street 2:STE, E
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5733
Mailing Address - Country:US
Mailing Address - Phone:530-533-6252
Mailing Address - Fax:530-533-6112
Practice Address - Street 1:455 ORO DAM BLVD E
Practice Address - Street 2:STE, E
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5733
Practice Address - Country:US
Practice Address - Phone:530-533-6252
Practice Address - Fax:530-533-6112
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice