Provider Demographics
NPI:1295984540
Name:VAIL, SALLY M (DDS)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:M
Last Name:VAIL
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 1:64 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2811
Mailing Address - Country:US
Mailing Address - Phone:860-536-7100
Mailing Address - Fax:860-572-0644
Practice Address - Street 1:64 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2811
Practice Address - Country:US
Practice Address - Phone:860-536-7100
Practice Address - Fax:860-572-0644
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71181223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice