Healthcare Provider Details

I. General information

NPI: 1366720013
Provider Name (Legal Business Name): SUSAN M. MIKLOS EFDA,RDH, BSDH, MSDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 BUTTONWOODS AVE
WARWICK RI
02886-7541
US

IV. Provider business mailing address

226 BUTTONWOODS AVE
WARWICK RI
02886-7541
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-9090
  • Fax:
Mailing address:
  • Phone: 401-732-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDHA02954
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number006553
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: