Individual
JOSEPH GATENS VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, INC
Contact information
Practice address
130 CEDAR KNOLL DR, RONCEVERTE, WV 24970-8446
(304) 645-3333
(304) 647-5932
Mailing address
130 CEDAR KNOLL DR, RONCEVERTE, WV 24970-8446
(304) 645-2333
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3268
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000804538
BC/BS ID NUMBER
WV
05
—
0134332000
—
WV
01
—
804538
UNITED CONCORDIA ID NUMBE
WV
Enumeration date
07/19/2006
Last updated
05/16/2024
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