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General NPI Number Information
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NPI Number | 1093696411
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Entity Type | Organization
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Legal Business Name | LEBANON PETR VAUGHAN DDS LLC
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 600 COLUMBUS AVE
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City | LEBANON
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State | OH
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Zip | 45036-1606
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Country | US
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Telephone | 937-453-8410
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Fax |
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Provider Business Mailing Address
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Address Line | 4881 COOPER RD
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City | CINCINNATI
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State | OH
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Zip | 45242-6902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETR VAUGHAN
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Credential | DDS
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Telephone | 937-245-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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