=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952501769
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY VAUGHN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 07/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 1ST AVE W 100
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-4253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-285-5000
-----------------------------------------------------
Fax | 206-285-5040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 1ST AVE W 100
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-4253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-285-5000
-----------------------------------------------------
Fax | 206-285-5040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE00009047
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------