Provider Demographics
NPI:1528224672
Name:VAUGHN, SHARCOLA DENISE (DMD)
Entity type:Individual
Prefix:
First Name:SHARCOLA
Middle Name:DENISE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 GODBY RD
Mailing Address - Street 2:STE D
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3336
Mailing Address - Country:US
Mailing Address - Phone:404-763-3326
Mailing Address - Fax:404-763-3073
Practice Address - Street 1:2177 GODBY RD
Practice Address - Street 2:STE D
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3336
Practice Address - Country:US
Practice Address - Phone:404-763-3326
Practice Address - Fax:404-763-3073
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist