Healthcare Provider Details

I. General information

NPI: 1487376927
Provider Name (Legal Business Name): JOSEPH ANDREW VAUGHN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 W 11TH ST
SEDALIA MO
65301-5221
US

IV. Provider business mailing address

3520 ASHLAND LN
SEDALIA MO
65301-2481
US

V. Phone/Fax

Practice location:
  • Phone: 660-530-0209
  • Fax:
Mailing address:
  • Phone: 361-935-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2021048141
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: