Healthcare Provider Details

I. General information

NPI: 1326054156
Provider Name (Legal Business Name): VAUGHT, BURCHARD & ASSOC. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 S PITTSBURG AVE
TULSA OK
74114-6133
US

IV. Provider business mailing address

2902 S PITTSBURG AVE
TULSA OK
74114-6133
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-8868
  • Fax: 918-742-2030
Mailing address:
  • Phone: 918-748-8868
  • Fax: 918-742-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4072
License Number StateOK

VIII. Authorized Official

Name: DR. ELMER JOSIAH VAUGHT JR.
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 918-748-8868