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General NPI Number Information
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NPI Number | 1073485504
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Entity Type | Individual
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Provider Name | DR. BRIENA ARIANA VAUGHN
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Gender | Female
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2037 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-3362
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Country | US
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Telephone | 773-489-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1617 S CANDLESTICK WAY
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City | WAUKEGAN
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State | IL
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Zip | 60085-8670
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Country | US
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Telephone | 847-406-8879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.036483
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License Number State | IL
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