Healthcare Provider Details

I. General information

NPI: 1689069023
Provider Name (Legal Business Name): LAURA ANN MILLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DURHAM RD SUITE 20
MADISON CT
06443-2676
US

IV. Provider business mailing address

141 DURHAM RD SUITE 20
MADISON CT
06443-2676
US

V. Phone/Fax

Practice location:
  • Phone: 203-245-9607
  • Fax: 203-245-1217
Mailing address:
  • Phone: 203-245-9607
  • Fax: 203-245-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number007660
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LAURA ANN MILLER COZEAN
Title or Position: OWNER
Credential: DDS
Phone: 203-245-9607