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General NPI Number Information
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NPI Number | 1972747111
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Entity Type | Individual
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Provider Name | LAUREN JILL POWERS DMD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 17 5 WEST ROAD
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City | ELLINGTON
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State | CT
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Zip | 06029
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Country | US
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Telephone | 860-872-2452
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Fax |
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Provider Business Mailing Address
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Address Line | 164 CARRIAGE DR
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2104
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1855088
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | CT010468
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 1223G0001X
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License Number State | CT
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