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General NPI Number Information
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NPI Number | 1245033356
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Entity Type | Organization
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Legal Business Name | HARRISON PETR VAUGHAN, DDS, LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1003 HARRISON AVE STE 300
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City | HARRISON
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State | OH
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Zip | 45030-2132
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Country | US
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Telephone | 513-367-4048
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 HARRISON AVE STE 300
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City | HARRISON
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State | OH
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Zip | 45030-2132
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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 | CEO
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Name | PETR ALEXANDER VAUGHAN
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Credential | DDS
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Telephone | 513-367-4048
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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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