Provider Demographics
NPI:1457511420
Name:VAUGHAN, KEITH E (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:E
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 1:104 ALBACORE DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2913
Mailing Address - Country:US
Mailing Address - Phone:757-369-8860
Mailing Address - Fax:757-898-7390
Practice Address - Street 1:6521 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2169
Practice Address - Country:US
Practice Address - Phone:757-898-3366
Practice Address - Fax:757-898-7390
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice