Provider Demographics
NPI:1689923062
Name:MILLER, PATRICIA LUTKUS (RDH)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LUTKUS
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2094
Mailing Address - Street 2:HGLHC
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06145-2094
Mailing Address - Country:US
Mailing Address - Phone:860-278-4163
Mailing Address - Fax:860-278-5995
Practice Address - Street 1:1841 BROAD ST
Practice Address - Street 2:HGLHC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1780
Practice Address - Country:US
Practice Address - Phone:860-278-4163
Practice Address - Fax:860-278-5995
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002904124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist