Provider Demographics
NPI:1427249838
Name:HOWARD W. TOLK, D.D.S. & VERNON D. DOMMU, D.M.D., P.C.
Entity type:Organization
Organization Name:HOWARD W. TOLK, D.D.S. & VERNON D. DOMMU, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOMMU
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:203-336-1275
Mailing Address - Street 1:195 TUNXIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4498
Mailing Address - Country:US
Mailing Address - Phone:203-336-1275
Mailing Address - Fax:203-335-5038
Practice Address - Street 1:195 TUNXIS HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4498
Practice Address - Country:US
Practice Address - Phone:203-336-1275
Practice Address - Fax:203-335-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty