Provider Demographics
NPI:1336395177
Name:VAUGHAN, VICTOR LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:LAWRENCE
Last Name:VAUGHAN
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 1:1530 E HINTZ RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2209
Mailing Address - Country:US
Mailing Address - Phone:847-394-3070
Mailing Address - Fax:847-394-6043
Practice Address - Street 1:1530 E HINTZ RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-2209
Practice Address - Country:US
Practice Address - Phone:847-394-3070
Practice Address - Fax:847-394-6043
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190184281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice