Provider Demographics
NPI:1346658051
Name:VUKOVIC, SANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:VUKOVIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S WHITTLESEY AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4101
Mailing Address - Country:US
Mailing Address - Phone:203-265-3139
Mailing Address - Fax:203-265-5133
Practice Address - Street 1:51 S WHITTLESEY AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4101
Practice Address - Country:US
Practice Address - Phone:203-265-3139
Practice Address - Fax:203-265-5133
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1346658051Medicaid