MEDICARE: DR. MARK 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	12012703A	IN

General Provider Information

NPI Number	:	1891224028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK VAUGHN DDS

Provider Business Mailing Address
First Line	:	10460 AFFIRMED CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-7635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-412-2170
Fax Number	:

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

Provider Enumeration Date	:	06/10/2017
Last Update Date	:	06/10/2017

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