Provider Demographics
NPI:1114091766
Name:BUREAU, BETH ANN (DDS)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BUREAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516
Mailing Address - Country:US
Mailing Address - Phone:203-932-5818
Mailing Address - Fax:
Practice Address - Street 1:655 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:WESTHAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-932-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice