Provider Demographics
NPI:1598209017
Name:DAWN M MIKAITIS DMD LLC
Entity Type:Organization
Organization Name:DAWN M MIKAITIS DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-729-9248
Mailing Address - Street 1:207 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4003
Mailing Address - Country:US
Mailing Address - Phone:203-729-9248
Mailing Address - Fax:
Practice Address - Street 1:207 MEADOW ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4003
Practice Address - Country:US
Practice Address - Phone:203-729-9248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty