Provider Demographics
NPI:1982729174
Name:DOMMU, VERNON D (DMD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:D
Last Name:DOMMU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 TUNXIS HILL CUTOFF SOUTH
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:203-336-1275
Mailing Address - Fax:203-335-5038
Practice Address - Street 1:195 TUNXIS HILL CUTOFF SOUTH
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-336-1275
Practice Address - Fax:203-335-5038
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT5175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist