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General NPI Number Information
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NPI Number | 1598209017
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Entity Type | Organization
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Legal Business Name | DAWN M MIKAITIS DMD LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 207 MEADOW ST
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City | NAUGATUCK
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State | CT
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Zip | 06770-4003
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Country | US
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Telephone | 203-729-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 207 MEADOW ST
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City | NAUGATUCK
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State | CT
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Zip | 06770-4003
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Country | US
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Telephone | 203-729-9248
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAWN MIKAITIS
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Credential |
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Telephone | 203-729-9248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 008378
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License Number State | CT
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