MEDICARE: DR. KEITH E VAUGHAN D.D.S.

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	0401412135	VA

General Provider Information

NPI Number	:	1457511420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH E VAUGHAN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 1207
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-1207
Country	:	US
Telephone Number	:	757-898-3366
Fax Number	:	757-898-7390

Provider Business Practice Location Address
First Line	:	6521 GEORGE WASHINGTON MEM HWY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2169
Country	:	US
Telephone Number	:	757-898-3366
Fax Number	:	757-898-7390

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

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	02/14/2026

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