Provider Demographics
NPI:1972506780
Name:MILLER, LAURA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DURHAM RD
Mailing Address - Street 2:STE 20
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2657
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:STE 20
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2657
Practice Address - Country:US
Practice Address - Phone:203-245-9607
Practice Address - Fax:203-245-1217
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT76601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice