Organization
KELLY A. VAUGHN
Active
Other names
Woodstock Dental Care PC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANITA L FALVAI (PRACTICE ADMIN)
(770) 928-4511
Entity
Organization
Contact information
Practice address
9020 HIGHWAY 92, SUITE 120, WOODSTOCK, GA 30189-3753
(770) 928-4511
(770) 928-4310
Mailing address
9020 HIGHWAY 92, SUITE 120, WOODSTOCK, GA 30189-3753
(770) 928-4511
(770) 928-4310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012608
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211792479N
—
GA
Enumeration date
03/20/2008
Last updated
04/02/2012
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