Healthcare Provider Details

I. General information

NPI: 1790607059
Provider Name (Legal Business Name): KENDRA DAWN VAUGHN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 2ND AVE S STE 203
GREAT FALLS MT
59405-1831
US

IV. Provider business mailing address

902 VALLEY DR
GLASGOW MT
59230-8405
US

V. Phone/Fax

Practice location:
  • Phone: 406-791-9267
  • Fax: 406-791-9277
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN-DEN-LIC-33497
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: