Provider Demographics
NPI:1083759609
Name:VATAFU, IOAN LUCIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:IOAN
Middle Name:LUCIAN
Last Name:VATAFU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 THORNBUSH RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3554
Mailing Address - Country:US
Mailing Address - Phone:860-257-4174
Mailing Address - Fax:
Practice Address - Street 1:1247 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3031
Practice Address - Country:US
Practice Address - Phone:860-666-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0095161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice