MEDICARE: DAVID K BURAN DMD PC

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	10535	GA

General Provider Information

NPI Number	:	1700998424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID K BURAN DMD PC

Provider Business Mailing Address
First Line	:	4485 NORTH TOWN SQUARE
Second Line	:	STE 100
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2242
Country	:	US
Telephone Number	:	770-943-0701
Fax Number	:	770-943-7666

Provider Business Practice Location Address
First Line	:	4485 NORTH TOWN SQUARE
Second Line	:	STE 100
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2242
Country	:	US
Telephone Number	:	770-943-0701
Fax Number	:	770-943-7666

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID K BURAN
Credential	:	DMD
Telephone Number	:	770-943-0701

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/17/2008

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