Provider Demographics
NPI:1487376927
Name:VAUGHN, JOSEPH ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 ASHLAND LN
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2481
Mailing Address - Country:US
Mailing Address - Phone:361-935-5575
Mailing Address - Fax:
Practice Address - Street 1:1716 W 11TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5221
Practice Address - Country:US
Practice Address - Phone:660-530-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210481411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty