MEDICARE: MICHAEL D VAUGHAN DDS AND ASSOCIATES OF CHATTANOOGA PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1598466260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D VAUGHAN DDS AND ASSOCIATES OF CHATTANOOGA PLLC

Provider Business Mailing Address
First Line	:	3429A 33RD AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-4001
Country	:	US
Telephone Number	:	615-397-4483
Fax Number	:

Provider Business Practice Location Address
First Line	:	5959 SHALLOWFORD RD STE 539
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2240
Country	:	US
Telephone Number	:	425-325-9700
Fax Number	:	423-325-9701

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL DARREN VAUGHAN
Credential	:	DDS
Telephone Number	:	615-397-4483

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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