Healthcare Provider Details

I. General information

NPI: 1346453321
Provider Name (Legal Business Name): LEONARD STEPHEN VAUGHAN DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DRIVE SUITE 105
FOOTHILL RANCH CA
92610
US

IV. Provider business mailing address

26730 TOWNE CENTRE DRIVE SUITE 105
FOOTHILL RANCH CA
92610
US

V. Phone/Fax

Practice location:
  • Phone: 949-297-8880
  • Fax: 949-297-8883
Mailing address:
  • Phone: 949-297-8880
  • Fax: 949-297-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOMS 61
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: