Healthcare Provider Details

I. General information

NPI: 1063347680
Provider Name (Legal Business Name): WHITE MARSH DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5103 GEORGE WASHINGTON MEMORIAL HWY
HAYES VA
23072-2823
US

IV. Provider business mailing address

5103 GEORGE WASHINGTON MEMORIAL HWY
HAYES VA
23072-2823
US

V. Phone/Fax

Practice location:
  • Phone: 757-870-4358
  • Fax:
Mailing address:
  • Phone: 757-870-4358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LANEY VAUGHAN
Title or Position: OWNER / GENERAL DENTIST
Credential: DDS
Phone: 757-870-4358