MEDICARE: DR. ROBERT D VAUGHAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6902	NC

General Provider Information

NPI Number	:	1053457317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D VAUGHAN DDS

Provider Business Mailing Address
First Line	:	16600 BIRKDALE CMNS PKWY
Second Line	:	SUITE A
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-6181
Country	:	US
Telephone Number	:	704-655-8008
Fax Number	:	704-655-8007

Provider Business Practice Location Address
First Line	:	16600 BIRKDALE CMNS PKWY
Second Line	:	SUITE A
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-6181
Country	:	US
Telephone Number	:	704-655-8008
Fax Number	:	704-655-8007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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