Healthcare Provider Details

I. General information

NPI: 1033412036
Provider Name (Legal Business Name): ROBERT A. VAUGHT D.M.D.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 US HIGHWAY 17 SUITE 2B
RICHMOND HILL GA
31324-3799
US

IV. Provider business mailing address

PO BOX 1918
RICHMOND HILL GA
31324-1918
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-2309
  • Fax:
Mailing address:
  • Phone: 912-756-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11121
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: