MEDICARE: MRS. LILIA VAUGHAN RDH,BSDH

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	124Q00000X	Dental Hygienist	07591	NC

General Provider Information

NPI Number	:	1912565599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILIA VAUGHAN RDH,BSDH

Provider Business Mailing Address
First Line	:	9225 DOERR RD BLDG 1220
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-6006
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 DOERR RD BLDG 1220
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-6006
Fax Number	:

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

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	06/14/2022

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