NPIMap

Organization Active NPI

Milford Lisa Rudolph DMD MPH and Petr Vaughan DDS, LLC

  • Pediatric Dentistry
  • Milford, OH
National Provider Identifier
1407603558
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
MILFORD LISA RUDOLPH DMD MPH AND PETR VAUGHAN DDS, LLC
Practice address
1106C Main St
Milford, OH 45150-1706
Phone
(513) 831-3434
NPI assigned
May 6, 2024
Last updated
May 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Authorized official

Name
Petr Alexander Vaughan, DDSNPI 1316576556
Title
Ceo/Co-Founder
Phone
(937) 245-0390

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

1106C Main St
Milford, OH 45150-1706

Mailing address

5310 Wakefield PL
Norwood, OH 45212-1737
Phone (937) 245-0390

National Provider Directory

National Provider Directory

Locations

1106C Main St
Milford, OH 45150
Phone (513) 831-3434

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1407603558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 WAKEFIELD PL",
            "city": "NORWOOD",
            "state": "OH",
            "postal_code": "452121737",
            "telephone_number": "937-245-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106C MAIN ST",
            "city": "MILFORD",
            "state": "OH",
            "postal_code": "451501706",
            "telephone_number": "513-831-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILFORD LISA RUDOLPH DMD MPH AND PETR VAUGHAN DDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "PETR",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "CEO/CO-FOUNDER",
        "authorized_official_telephone_number": "937-245-0390",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.