Provider Demographics
NPI:1891905048
Name:STRAIT, A VANDIVEER (DDS)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:VANDIVEER
Last Name:STRAIT
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 1:113 E CROSS RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1108
Mailing Address - Country:US
Mailing Address - Phone:203-322-5547
Mailing Address - Fax:
Practice Address - Street 1:44 OLD RIDGEFIELD RD
Practice Address - Street 2:SUITE 212
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3055
Practice Address - Country:US
Practice Address - Phone:203-761-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist