Provider Demographics
NPI:1326319831
Name:POSNER, BETH AGELOFF (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:AGELOFF
Last Name:POSNER
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 1:420 FLINTLOCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1090
Mailing Address - Country:US
Mailing Address - Phone:203-256-0841
Mailing Address - Fax:203-256-0841
Practice Address - Street 1:420 FLINTLOCK RD
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1090
Practice Address - Country:US
Practice Address - Phone:203-256-0841
Practice Address - Fax:203-256-0841
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002069707Medicaid
CT190000849Medicare UPIN