Individual provider Active NPI

Vernon D Dommu, DMD

  • Dentist
  • Fairfield, CT
National Provider Identifier
1982729174
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
CT5175 Issued in CT
Practice address
195 Tunxis Hill Cutoff South
Fairfield, CT 06825
Phone
(203) 336-1275
Fax
(203) 335-5038
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X CT5175 CT Primary

Addresses

Primary practice location

195 Tunxis Hill Cutoff South
Fairfield, CT 06825

Mailing address

195 Tunxis Hill Cutoff South
Fairfield, CT 06825
Phone (203) 336-1275

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150323000913 CT Order and Referring Only - DentistPractitioner - Dentist 1153648688

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5175CTMDClinical Psychologist
CT5175CTMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Howard W. Tolk, D.D.S. & Vernon D. Dommu, D.M.D., P.C. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982729174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 TUNXIS HILL CUTOFF SOUTH",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06825",
            "telephone_number": "203-336-1275",
            "fax_number": "203-335-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 TUNXIS HILL CUTOFF SOUTH",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06825",
            "telephone_number": "203-336-1275",
            "fax_number": "203-335-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMMU",
        "first_name": "VERNON",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "CT5175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.