Healthcare Provider Details

I. General information

NPI: 1235596149
Provider Name (Legal Business Name): VAUGHN CALL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 CABEZON BLVD SE
RIO RANCHO NM
87124-1515
US

IV. Provider business mailing address

15407 S CAMINO AGUA AZUL
SAHUARITA AZ
85629-8854
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-5437
  • Fax:
Mailing address:
  • Phone: 623-340-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD4447
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: