Provider Demographics
NPI:1598881856
Name:VITUKINAS, LEIGH-LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:LEIGH-LYNN
Middle Name:
Last Name:VITUKINAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6427
Mailing Address - Country:US
Mailing Address - Phone:860-489-1328
Mailing Address - Fax:860-489-4761
Practice Address - Street 1:405 W WAKEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-2955
Practice Address - Country:US
Practice Address - Phone:860-379-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006620124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006620OtherDH LICENSE