MEDICARE: BURBA DENTAL PARTNERS

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

General Provider Information

NPI Number	:	1336335298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURBA DENTAL PARTNERS

Provider Business Mailing Address
First Line	:	129 HIGHLAND AVE
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-2774
Country	:	US
Telephone Number	:	978-744-7575
Fax Number	:	978-744-8577

Provider Business Practice Location Address
First Line	:	129 HIGHLAND AVE
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-2774
Country	:	US
Telephone Number	:	978-744-7575
Fax Number	:	978-744-8577

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDALL S. BURBA
Credential	:	D.M.D.
Telephone Number	:	978-744-7575

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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Directions to “BURBA DENTAL PARTNERS ” Practice Location

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