Provider Demographics
NPI:1104821289
Name:TEUSCHER, VAUGHN W (DDS)
Entity type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:W
Last Name:TEUSCHER
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 1:2415 SE 165TH AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4324
Mailing Address - Country:US
Mailing Address - Phone:360-256-1202
Mailing Address - Fax:360-885-3580
Practice Address - Street 1:2415 SE 165TH AVE
Practice Address - Street 2:STE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4324
Practice Address - Country:US
Practice Address - Phone:360-256-1202
Practice Address - Fax:360-885-3580
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000065021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5017140Medicaid
WA56502OtherWASHINGTON DENTAL SERVICE
WA146076OtherDEPT. OF L&I