MEDICARE: DR. JESSICA L VAUGHN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	60998	KS

General Provider Information

NPI Number	:	1588004378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA L VAUGHN DDS

Provider Business Mailing Address
First Line	:	5536 NE ANTIOCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2301
Country	:	US
Telephone Number	:	816-413-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	5536 NE ANTIOCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2301
Country	:	US
Telephone Number	:	816-413-9009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	01/26/2016

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