Provider Demographics
NPI:1477651321
Name:VAUGHAN, DARLENE KAYE (DDS)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:KAYE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1995
Mailing Address - Country:US
Mailing Address - Phone:317-253-4426
Mailing Address - Fax:317-251-6855
Practice Address - Street 1:6214 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1995
Practice Address - Country:US
Practice Address - Phone:317-253-4426
Practice Address - Fax:317-251-6855
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice