Provider Demographics
NPI:1346374667
Name:LEARY, BETTY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:LEARY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FALCON CRST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2181
Mailing Address - Country:US
Mailing Address - Phone:203-230-2384
Mailing Address - Fax:203-235-6337
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-5119
Practice Address - Country:US
Practice Address - Phone:203-235-0121
Practice Address - Fax:203-235-6337
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice