Provider Demographics
NPI:1689069023
Name:LAURA ANN MILLER
Entity Type:Organization
Organization Name:LAURA ANN MILLER
Other - Org Name:WE CREATE SMILES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER COZEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-245-9607
Mailing Address - Street 1:141 DURHAM RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2676
Mailing Address - Country:US
Mailing Address - Phone:203-245-9607
Mailing Address - Fax:203-245-1217
Practice Address - Street 1:141 DURHAM RD
Practice Address - Street 2:SUITE 20
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2676
Practice Address - Country:US
Practice Address - Phone:203-245-9607
Practice Address - Fax:203-245-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007660122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002076603Medicaid