Provider Demographics
NPI:1174907695
Name:VAUGHN, AMIEE M (DMD)
Entity type:Individual
Prefix:DR
First Name:AMIEE
Middle Name:M
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W INDIANTOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7557
Mailing Address - Country:US
Mailing Address - Phone:561-747-7172
Mailing Address - Fax:
Practice Address - Street 1:651 W INDIANTOWN RD STE A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7557
Practice Address - Country:US
Practice Address - Phone:561-747-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9633122300000X
FL22192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist