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General NPI Number Information
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NPI Number | 1366720013
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Entity Type | Individual
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Provider Name | SUSAN M. MIKLOS EFDA,RDH, BSDH, MSDH
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Gender | Female
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 126 PARK AVE
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City | BRIDGEPORT
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State | CT
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Zip | 06604-7620
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Country | US
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Telephone | 203-576-4823
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Fax |
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Provider Business Mailing Address
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Address Line | 114 SQUIRES RD
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City | MADISON
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State | CT
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Zip | 06443-1792
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Country | US
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Telephone | 203-915-1666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 006553
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License Number State | CT
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