Provider Demographics
NPI:1225046022
Name:MIKAITIS, DAWN MARIE (DMD)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:MIKAITIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479
Mailing Address - Country:US
Mailing Address - Phone:860-426-1520
Mailing Address - Fax:
Practice Address - Street 1:207 MEADOW STREET
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770
Practice Address - Country:US
Practice Address - Phone:203-729-9248
Practice Address - Fax:203-723-9813
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist