Kristin Marie Vaught, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019032292 Issued in IL

Practice address

595 N Broadway St
Coal City, IL 60416-1046

Phone

(815) 634-8009

Fax

(815) 634-2008

NPI assigned

Aug 20, 2019

Last updated

Aug 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Broadway Family Dental Center

  • General Practice Dentistry
  • Coal City, IL
  • NPI 1922378900
  NPD (past)
• Pullara Family Dental Center

  dba Plainfield Family Dental Center

  • General Practice Dentistry
  • Coal City, IL
  • NPI 1821201575
  NPD (past)

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

{
    "created_epoch": "1566259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1669029245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 WILDY RD",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604479795",
            "telephone_number": "815-830-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N BROADWAY ST",
            "city": "COAL CITY",
            "state": "IL",
            "postal_code": "604161046",
            "telephone_number": "815-634-8009",
            "fax_number": "815-634-2008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2630 Flossmoor Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Flossmoor",
            "state": "IL",
            "postal_code": "604221560",
            "country_code": "US",
            "telephone_number": "708-798-0990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHT",
        "first_name": "KRISTIN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-20",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019032292",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019032292",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Total Renal Care Inc (Coal City Home Training)
• Robin Trevison, D.M.D
• Christine Trofimchuck, D.C.
• Jenna Valentine
• Brent Vanduyne, PHARMD
• Elizabeth A. Venice, APN
• Christina Veronda, LMT
• Vision Medical Supplies LLC
• Kailee J Walgren, LCSW
• Wanderlust Wellness Counseling LLC

• Dentist in Coal City, IL
• Providers in Coal City, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.