Provider Demographics
NPI:1982152542
Name:VAUGHAN, MATTHEW ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27001 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3183
Mailing Address - Country:US
Mailing Address - Phone:931-427-8581
Mailing Address - Fax:931-427-8588
Practice Address - Street 1:27001 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449-3183
Practice Address - Country:US
Practice Address - Phone:931-427-8581
Practice Address - Fax:931-427-8588
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL63211223G0001X
TN112391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice