Provider Demographics
NPI:1649447848
Name:VAUGHAN, GLORIA GAIL (DDS)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:GAIL
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 1:137 WAGON TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1241
Mailing Address - Country:US
Mailing Address - Phone:210-493-7281
Mailing Address - Fax:
Practice Address - Street 1:137 WAGON TRAIL RD
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1241
Practice Address - Country:US
Practice Address - Phone:210-493-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice