MEDICARE: DR. JOHN BURBANK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0012281	FL

General Provider Information

NPI Number	:	1053593806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BURBANK D.D.S.

Provider Business Mailing Address
First Line	:	7838 SW 103RD LOOP
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34476-3767
Country	:	US
Telephone Number	:	352-873-0434
Fax Number	:

Provider Business Practice Location Address
First Line	:	8389 S SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA
State	:	FL
Zip	:	34446-5028
Country	:	US
Telephone Number	:	352-382-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	09/27/2010

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