Healthcare Provider Details

I. General information

NPI: 1235072638
Provider Name (Legal Business Name): THOMAS MARK ALUN VAUGHAN BDS FDS MORTH. MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST
SAN FRANCISCO CA
94103
US

IV. Provider business mailing address

27 PARK RIDGE RD
SAN RAFAEL CA
94903-1816
US

V. Phone/Fax

Practice location:
  • Phone: 415-706-7446
  • Fax:
Mailing address:
  • Phone: 650-398-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberSP334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: