Provider Demographics
NPI:1023447869
Name:LORENIA VAUGHN,DDS,INC.
Entity type:Organization
Organization Name:LORENIA VAUGHN,DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENIA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-730-5955
Mailing Address - Street 1:301 MISSION AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2570
Mailing Address - Country:US
Mailing Address - Phone:760-730-5955
Mailing Address - Fax:760-730-5966
Practice Address - Street 1:301 MISSION AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2565
Practice Address - Country:US
Practice Address - Phone:760-877-4569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty