Individual provider Active NPI

Thomas C Vaughan III, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Fayetteville, AR
National Provider Identifier
1750796322
Registry record updated Nov 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
4014 Issued in AR
Practice address
2025 N Green Acres Rd
Fayetteville, AR 72703-2619
Phone
(479) 202-8666
Fax
(844) 315-4115
NPI assigned
Jun 23, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 4014 AR Primary

Addresses

Primary practice location

2025 N Green Acres Rd
Fayetteville, AR 72703-2619

Mailing address

2025 N Green Acres Rd
Fayetteville, AR 72703-2619
Phone (479) 202-8666

Other practice location 1

2300 S 58th St Ste C
Fort Smith, AR 72903-3825
Phone (479) 202-8666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200629003140 TX Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 2365741428

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4014ARMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Osct, PLLC Oral and Maxillofacial Surgery CurrentSince Jul 1, 2020 Accepting new patients
University of Frida Past Accepting new patients

Locations

2903 N FM 1417
Sherman, TX 75092
Phone (903) 868-1370

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763337600000",
    "number": "1750796322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 N GREEN ACRES RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032619",
            "telephone_number": "479-202-8666",
            "fax_number": "844-315-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 N GREEN ACRES RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032619",
            "telephone_number": "479-202-8666",
            "fax_number": "844-315-4115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 S 58th St Ste C",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729033825",
            "country_code": "US",
            "telephone_number": "479-202-8666",
            "fax_number": "844-315-4115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "THOMAS",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "4014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.