Provider Demographics
NPI:1255570552
Name:PRESTON, MELAURA (DMD)
Entity type:Individual
Prefix:DR
First Name:MELAURA
Middle Name:
Last Name:PRESTON
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 1:126 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3355
Mailing Address - Country:US
Mailing Address - Phone:973-985-9785
Mailing Address - Fax:
Practice Address - Street 1:1888 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2357
Practice Address - Country:US
Practice Address - Phone:860-970-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT115281223G0001X
NJ239521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice