MEDICARE: BREAH E BURKHALTER

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	6001	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780825273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREAH E BURKHALTER

Provider Business Mailing Address
First Line	:	8894 AIRLINE HWY
Second Line	:	SUITE M
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4081
Country	:	US
Telephone Number	:	225-218-9218
Fax Number	:

Provider Business Practice Location Address
First Line	:	8894 AIRLINE HWY
Second Line	:	SUITE M
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4081
Country	:	US
Telephone Number	:	225-218-9218
Fax Number	:

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

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	01/19/2012

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Directions to “ BREAH E BURKHALTER ” Practice Location

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