Individual
DR. TY BRADLEY VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
320 NE 5TH ST, GRESHAM, OR 97030-7308
(503) 665-0495
(503) 674-9196
Mailing address
320 NE 5TH ST, GRESHAM, OR 97030-7308
(503) 665-0495
(503) 674-9196
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D9588
OR
1223G0001X
General Practice Dentistry
DE 60152137
WA
Other
Enumeration date
07/21/2008
Last updated
08/03/2016
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