Provider Demographics
NPI:1144496464
Name:VAUGHAN, PATRICK BERRY (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:BERRY
Last Name:VAUGHAN
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 1:194 PLEASANT ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2952
Mailing Address - Country:US
Mailing Address - Phone:603-225-3482
Mailing Address - Fax:
Practice Address - Street 1:194 PLEASANT ST
Practice Address - Street 2:SUITE 13
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-225-3482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH036551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery