Healthcare Provider Details

I. General information

NPI: 1144496464
Provider Name (Legal Business Name): PATRICK BERRY VAUGHAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 PLEASANT ST SUITE 13
CONCORD NH
03301-2952
US

IV. Provider business mailing address

194 PLEASANT ST SUITE 13
CONCORD NH
03301-2952
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-3482
  • Fax:
Mailing address:
  • Phone: 603-225-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number03655
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: