Provider Demographics
NPI:1376839571
Name:VAUGHAN, PHOEBE (DDS)
Entity type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PHOEBE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3613
Mailing Address - Country:US
Mailing Address - Phone:405-348-2266
Mailing Address - Fax:405-341-1473
Practice Address - Street 1:1201 N STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-5222
Practice Address - Fax:405-271-7538
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice