Provider Demographics
NPI:1972848190
Name:HAYES-LUTIAN, LINDA MARIE (RDH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:HAYES-LUTIAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:419 W RUTLAND RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2470
Mailing Address - Country:US
Mailing Address - Phone:203-878-8965
Mailing Address - Fax:203-878-8965
Practice Address - Street 1:419 W RUTLAND RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2470
Practice Address - Country:US
Practice Address - Phone:203-878-8965
Practice Address - Fax:203-878-8965
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003307124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist