Healthcare Provider Details

I. General information

NPI: 1205365186
Provider Name (Legal Business Name): DR. VINCENT VAUGHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD RD
BETHESDA MD
20889-5611
US

IV. Provider business mailing address

15877 MEHERRIN WAY
WOODBRIDGE VA
22191-4266
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0064
  • Fax:
Mailing address:
  • Phone: 703-786-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: