Healthcare Provider Details

I. General information

NPI: 1376839571
Provider Name (Legal Business Name): PHOEBE VAUGHAN D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. PHOEBE BROWN

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

420 W 15TH ST
EDMOND OK
73013-3613
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5222
  • Fax: 405-271-7538
Mailing address:
  • Phone: 405-348-2266
  • Fax: 405-341-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6312
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: