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General NPI Number Information
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NPI Number | 1699177477
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Entity Type | Individual
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Provider Name | DENTY PAUL VAUGHN JR. DVM
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Gender | Male
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 240 WISE CENTER DR
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City | MISSISSIPPI STATE
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State | MS
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Zip | 39762
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Country | US
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Telephone | 662-325-3432
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6100 240 WISE CENTER DR
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City | MISSISSIPPI STATE
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State | MS
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Zip | 39762
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Country | US
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Telephone | 662-325-3432
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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 | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 2052
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 6328
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 12111
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License Number State | FL
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