Provider Demographics
NPI:1831283852
Name:BOGUSLAW, BETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:BOGUSLAW
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:1770 GRAND CONCOURSE
Mailing Address - Street 2:STE 2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5524
Mailing Address - Country:US
Mailing Address - Phone:718-901-8110
Mailing Address - Fax:718-901-8121
Practice Address - Street 1:1770 GRAND CONCOURSE
Practice Address - Street 2:STE 2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5524
Practice Address - Country:US
Practice Address - Phone:718-901-8110
Practice Address - Fax:718-901-8121
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY035800-11223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology