MEDICARE: LAUREN DULIEU PRESTI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	12200	CT
2	1223P0221X	Pediatric Dentistry	12721	CT

General Provider Information

NPI Number	:	1124521687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DULIEU PRESTI DMD

Provider Business Mailing Address
First Line	:	420 CANYON RIDGE DR
Second Line	:
City	:	BROAD BROOK
State	:	CT
Zip	:	06016-5601
Country	:	US
Telephone Number	:	401-215-4117
Fax Number	:

Provider Business Practice Location Address
First Line	:	392 SALEM TPKE
Second Line	:
City	:	BOZRAH
State	:	CT
Zip	:	06334-1519
Country	:	US
Telephone Number	:	401-215-4117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	06/08/2020

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