Lebanon Petr Vaughan DDS LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

LEBANON PETR VAUGHAN DDS LLC

Doing business as

Lebanon Pediatric Dentistry

Practice address

600 Columbus Ave
Lebanon, OH 45036-1606

Phone

(937) 453-8410

NPI assigned

Sep 11, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Petr Vaughan, DDS

Title

Owner

Phone

(937) 245-0390

Specialties & licenses 1

Addresses

Other names 1

• Lebanon Pediatric Dentistry Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1093696411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 COOPER RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452426902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COLUMBUS AVE",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450361606",
            "telephone_number": "937-453-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON PETR VAUGHAN DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-11",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "PETR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-245-0390",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lebanon Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Dentistry in Lebanon, OH
• Providers in Lebanon, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.