Healthcare Provider Details

I. General information

NPI: 1083302673
Provider Name (Legal Business Name): REBECCA MARY VIGNOGNA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/28/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 POST RD
FAIRFIELD CT
06824-5938
US

IV. Provider business mailing address

1177 MAMARONECK AVE
WHITE PLAINS NY
10605-4806
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-6851
  • Fax:
Mailing address:
  • Phone: 315-558-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14510
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: