Provider Demographics
NPI:1104161074
Name:VAUGHN A. LEE DDS INC.
Entity type:Organization
Organization Name:VAUGHN A. LEE DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-834-4640
Mailing Address - Street 1:373 NINTH ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6516
Mailing Address - Country:US
Mailing Address - Phone:510-834-4640
Mailing Address - Fax:510-834-8328
Practice Address - Street 1:373 NINTH ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6516
Practice Address - Country:US
Practice Address - Phone:510-834-4640
Practice Address - Fax:510-834-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB24471-01Medicaid