Healthcare Provider Details

I. General information

NPI: 1255570552
Provider Name (Legal Business Name): MELAURA PRESTON D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 MAIN ST
HARTFORD CT
06120-2357
US

IV. Provider business mailing address

126 WESTMINSTER DR
WEST HARTFORD CT
06107-3355
US

V. Phone/Fax

Practice location:
  • Phone: 860-970-0928
  • Fax:
Mailing address:
  • Phone: 973-985-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCT11528
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23952
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: