Provider Demographics
NPI:1114133915
Name:VAYNER, JACK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:VAYNER
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 1:1735 POST RD STE 8
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5700
Mailing Address - Country:US
Mailing Address - Phone:203-336-1275
Mailing Address - Fax:203-335-5038
Practice Address - Street 1:1735 POST RD STE 8
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5700
Practice Address - Country:US
Practice Address - Phone:203-336-1275
Practice Address - Fax:203-335-5038
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist