Organization
DR JOSEPH G VAUGHAN DDS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE RENEE BOSTIC (BUSINESS COORDINATOR)
(304) 645-2333
Entity
Organization
Contact information
Practice address
294 SENECA TRL, RONCEVERTE, WV 24970-1342
(304) 645-2333
(304) 647-5932
Mailing address
294 SENECA TRL, RONCEVERTE, WV 24970-1342
(304) 645-2333
(304) 647-5932
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3268
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134332000
—
WV
01
—
804538
UNITED CONCORDIA ID #
WV
Enumeration date
08/31/2006
Last updated
08/22/2020
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