Provider Demographics
NPI:1861912412
Name:VAUGHN, PATRICK T (MD, DMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:T
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:21701 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7536
Mailing Address - Country:US
Mailing Address - Phone:425-744-1724
Mailing Address - Fax:
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7536
Practice Address - Country:US
Practice Address - Phone:425-744-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-25
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72276204E00000X
MND13879204E00000X, 122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery